Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Jul 1, 2012
License(s)
66767 (WI), 036-142188 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 111 OAKWOOD RD | East Peoria, IL 61611-1853 | 309-740-4272 |
| LOCATION | 800 E CARPENTER ST | Springfield, IL 62769-3522 | 217-544-6464 |
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