Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
May 24, 2018
License(s)
085006649 (IL), 085006649 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 5145 N CALIFORNIA AVE OFC M331 | Chicago, IL 60625-3687 | |
| LOCATION | 5145 N CALIFORNIA AVE OFC M331 | Chicago, IL 60625 | 773-878-8200 |
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