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Organization
ACTIVE THERAPEUTICS, LLC
Active
Organization
ACTIVE THERAPEUTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL COLLURA (PRESIDENT)
(847) 829-8708
Entity
Organization
Contact information
Practice address
906 IL ROUTE 22, FOX RIVER GROVE, IL 60021-1905
(847) 742-5757
(847) 428-8615
Mailing address
906 IL ROUTE 22, FOX RIVER GROVE, IL 60021-1905
(847) 742-5757
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0384686-5
IL
Other
Enumeration date
04/04/2012
Last updated
04/04/2012
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