Individual
ALISA VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9601 W MAIN ST, BELLEVILLE, IL 62223-1415
(618) 917-2251
Mailing address
9601 W MAIN ST, BELLEVILLE, IL 62223-1415
(618) 917-2251
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
012.008627
IL
Other
Enumeration date
08/31/2018
Last updated
08/31/2018
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