Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
May 17, 2006
License(s)
036-107939 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 6740 NORTH MINNEHAHA | Lincolnwood, IL 60712-3109 | 847-692-5206 |
| LOCATION | 8118N MILWAUKEE AVE | Niles, IL 60714-2817 | 847-692-5206 |
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