Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jul 3, 2006
License(s)
036-115389 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1460 N HALSTED ST SUITE #505 | Chicago, IL 60642-2605 | 312-266-6462 |
| MAILING | 1460 N HALSTED ST SUITE #505 | Chicago, IL 60642-2605 | 312-266-6462 |
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