Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
May 24, 2016
License(s)
MT210938 (PA), MT210938 (PA), 036159004 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2160 S 1ST AVE | Maywood, IL 60153-3328 | 708-216-9000 |
| MAILING | 2160 S 1ST AVE | Maywood, IL 60153-3328 | 708-216-9000 |
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