Individual
KYASIA TRENAE BRUCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4031 W DAYTON ST, MCHENRY, IL 60050-8377
(815) 759-7086
Mailing address
4031 W DAYTON ST, MCHENRY, IL 60050-8377
(815) 759-7086
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/01/2023
Last updated
08/01/2023
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