Individual
MISS GRACE ELAINE EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1125 OLD HUNTER RUN, BYRON, IL 61010-1494
(815) 218-3979
Mailing address
1125 OLD HUNTER RUN, BYRON, IL 61010-1494
(815) 218-3979
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/22/2015
Last updated
04/22/2015
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