Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Oct 5, 2012
License(s)
085.004410 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2051 PLAINFIELD RD | Crest Hill, IL 60403-1865 | 815-741-4343 |
| MAILING | 801 YORK ST | Manitowoc, WI 54220-4630 | 920-663-9008 |
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