Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Sep 15, 2014
License(s)
209017899 (IL), 209017899 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1054 MARTIN LUTHER KING DR | Centralia, IL 62801-3000 | 618-244-0031 |
| MAILING | 1054 MARTIN LUTHER KING DR STE 223 | Centralia, IL 62801-3066 | 618-244-0031 |
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