Individual
ALICIA LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
220 HEATHER GLEN DR, AURORA, IL 60504-6689
(630) 450-2450
Mailing address
220 HEATHER GLEN DR, AURORA, IL 60504-6689
(630) 450-2450
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2017
Last updated
10/03/2017
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