Individual
MISS KELLEY DAGDICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 W PARK AVE, ROUND LAKE, IL 60073-3225
(847) 401-4198
Mailing address
415 W PARK AVE, ROUND LAKE, IL 60073-3225
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/01/2014
Last updated
07/01/2014
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