Organization
PROFESSIONAL DIAGNOSTIC SERVICE, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH DAVIS PH.D./MD (PRESIDENT)
(312) 491-0404
Entity
Organization
Contact information
Practice address
821 W VAN BUREN ST, CHICAGO, IL 60607-3517
(312) 491-0404
(312) 491-0505
Mailing address
821 W VAN BUREN ST, CHICAGO, IL 60607-3517
(312) 491-0404
(312) 491-0505
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A-3920-0003-A
IL
Other
Enumeration date
08/27/2008
Last updated
08/27/2008
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