Individual
ELDA JEAN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
208 JUNIPER ST, PARK FOREST, IL 60466
(708) 202-8387
Mailing address
PO BOX 488, PARK FOREST, IL 60466
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/04/2019
Last updated
09/04/2019
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