Individual
JESSICA L CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 W 9TH ST, COAL VALLEY, IL 61240-9120
(309) 644-2870
Mailing address
112 W 9TH ST, COAL VALLEY, IL 61240-9120
(309) 644-2870
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
IA
Other
Enumeration date
12/15/2020
Last updated
12/15/2020
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