Individual
MR. JESUS MANCILLA SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RSA
Contact information
Practice address
3538 W FULLERTON AVE, CHICAGO, IL 60647-2443
(773) 772-1212
Mailing address
8021 42ND CT, LYONS, IL 60534-1165
(708) 442-1172
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Enumeration date
03/05/2007
Last updated
07/08/2007
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