Individual
KENYA TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8454 S 86TH AVE, JUSTICE, IL 60458-1859
(331) 472-7511
Mailing address
8454 S 86TH AVE, JUSTICE, IL 60458-1859
(331) 472-7511
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
IL
Other
Enumeration date
08/24/2022
Last updated
08/24/2022
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