Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jul 31, 2008
License(s)
125.054464 (IL), 125.054464 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 417 S JEFFERSON ST APT 313B | Chicago, IL 60607-3819 | 312-786-1956 |
| LOCATION | 600 S PAULINA ST | Chicago, IL 60612-3806 | 312-942-5000 |
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