Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Apr 28, 2020
License(s)
085.007484 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 675 N SAINT CLAIR ST STE 21-100 | Chicago, IL 60611-5970 | 312-695-0990 |
| MAILING | 675 N SAINT CLAIR ST STE 21-100 | Chicago, IL 60611-5970 | 312-695-0990 |
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