Individual
MR. FRITZGERALD CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3623 173RD CT APT 5C, LANSING, IL 60438-1444
(773) 801-8683
Mailing address
3623 173RD CT APT 5C, LANSING, IL 60438-1444
(773) 801-8683
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
6550040207
IN
Other
Enumeration date
06/02/2011
Last updated
06/02/2011
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