Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Feb 13, 2023
License(s)
085009607 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 676 N SAINT CLAIR ST STE 2210 | Chicago, IL 60611-2922 | 312-695-6277 |
| MAILING | 676 N SAINT CLAIR ST STE 2210 | Chicago, IL 60611-2922 | 312-695-6277 |
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