Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Sep 27, 2006
License(s)
036079495 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 775541 | Chicago, IL 60677-5541 | |
| LOCATION | 1639 N ALPINE RD | Rockford, IL 61107-1449 | 815-229-9333 |
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