Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Apr 1, 2014
License(s)
142376 (CA), 036145831 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 3249 S. OAK PARK AVENUE | Berwyn, IL 60402 | 708-783-3403 |
| MAILING | 808 S WOOD ST RM 380 | Chicago, IL 60612-7300 |
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