Individual
RUSSELL ADAM LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1118 HAMPSHIRE ST, QUINCY, IL 62301-3027
(212) 222-6550
Mailing address
1118 HAMPSHIRE ST, QUINCY, IL 62301-3027
(212) 222-6550
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.003331
IL
Other
Enumeration date
06/27/2018
Last updated
06/27/2018
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