Organization
LCR PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LORETTA B. JOHNSON C.N.A. (OWNER)
(773) 431-1508
Entity
Organization
Contact information
Practice address
9237 S.PULASKI, STE. 2S, EVERGREEN PARK, IL 60805
(773) 431-1508
Mailing address
9237 S PULASKI RD, STE 2S, EVERGREEN PARK, IL 60805-1454
(773) 431-1508
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
302F00000X
IL
Other
Enumeration date
11/09/2015
Last updated
11/09/2015
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