Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Apr 7, 2020
License(s)
2021022427 (MO)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 800 E CARPENTER STREET BOX 43 | Springfield, IL 62769-0001 | 217-814-5178 |
| LOCATION | 800 E CARPENTER ST | Springfield, IL 62769-1000 | 217-814-5178 |
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