Individual
CLINTON LARISCY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3355 ILLINOIS ST, RECRUIT TRAINING COMMAND GREAT LAKES, GREAT LAKES, IL 60088
(847) 688-4643
Mailing address
3355 ILLINOIS ST, RECRUIT TRAINING COMMAND GREAT LAKES, GREAT LAKES, IL 60088
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
07/29/2010
Last updated
07/29/2010
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