Organization
BRONCOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN J LARSON (OWNER)
(217) 342-3218
Entity
Organization
Contact information
Practice address
813 N 3RD ST, SUITE 4, EFFINGHAM, IL 62401-3181
(217) 342-3218
(217) 342-3226
Mailing address
PO BOX 1527, EFFINGHAM, IL 62401-1527
(217) 342-3218
(217) 342-3226
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Enumeration date
12/29/2006
Last updated
01/19/2012
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