Individual
MR. VICTOR RICO SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10 N VIRGINIA ST, CRYSTAL LAKE, IL 60014-4139
(815) 459-3860
Mailing address
9419 CREEKSIDE DR, WONDER LAKE, IL 60097-7549
(815) 527-2999
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
227012244
IL
Other
Enumeration date
08/21/2014
Last updated
08/21/2014
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