Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Nov 20, 2007
License(s)
036125295 (IL), 125-052-665 (IL), 036125295 (IL), 256848 (MA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 554 GREEN BAY RD STE E | Kenilworth, IL 60043-1086 | 312-483-4397 |
| MAILING | 60 E DELAWARE PL STE 1450 | Chicago, IL 60611-6559 | 312-483-4397 |
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