Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jun 20, 2016
License(s)
2016017335 (MO), 036-153277 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 836 N MEACHAM RD | Schaumburg, IL 60173-4922 | 630-871-6690 |
| MAILING | PO BOX 713260 | Chicago, IL 60677-1260 | 630-469-9200 |
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