Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2015-03-17
- Last updated
- 2015-03-17
Specialties
Licenses
- License IL
- 146006630
Location
- Practice location
- 414 W HUNTER LN
- City
- MINOOKA IL
- Postal code
- 604474519
- Phone
- 815-474-2146
Organization contact
- Name
- SHELLEY MANNING
- Title
- OWNER
- Phone
- 8154742146
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
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