Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
May 21, 2007
License(s)
036122766 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 6015 N LEGETT AVE | Chicago, IL 60646-5631 | 312-622-6862 |
| LOCATION | 5363 W DEVON AVE | Chicago, IL 60646-4142 | 773-312-3880 |
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