Individual
RALPH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14847 VAIL AVE, HARVEY, IL 60426-1536
(773) 724-9433
Mailing address
12003 S PULASKI RD APT 256, ALSIP, IL 60803-1221
(708) 690-3845
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
C46272064039
IL
Other
Enumeration date
06/06/2019
Last updated
06/06/2019
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