Individual
MR. TERRY LEE CRADDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T, L.P.N.
Contact information
Practice address
120 S MAIN ST, FARMER CITY, IL 61842-1454
(309) 824-4373
Mailing address
120 S MAIN ST, FARMER CITY, IL 61842-1454
(309) 824-4373
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
IL
Other
Enumeration date
12/09/2007
Last updated
01/10/2008
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