Individual
JOAN K SELBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
120 NE GLEN OAK AVE, SUITE 407, PEORIA, IL 61603-4301
(309) 672-5975
(309) 655-1678
Mailing address
120 NE GLEN OAK AVE, SUITE 407, PEORIA, IL 61603-4301
(309) 672-5975
(309) 655-1678
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
102326
IL
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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