Organization
GREAT RIVER PAIN CLINIC LLC
Active
Organization
GREAT RIVER PAIN CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANJAY SUNDAR MD (PRESIDENT)
(312) 613-9999
Entity
Organization
Contact information
Practice address
555 N KELLOGG ST, GALESBURG, IL 61401-3726
(312) 613-9999
Mailing address
PO BOX 689, LAKE FOREST, IL 60045-0689
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Enumeration date
09/14/2015
Last updated
09/14/2015
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