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Organization

CENTERCORE MEDICAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CORENE MAVIGLIANO (OWNER)
(618) 713-6286
Entity
Organization

Contact information

Practice address
720 S PARK AVE, HERRIN, IL 62948-3816
(618) 713-6286
(618) 985-4636
Mailing address
704 GRACE LN, CARTERVILLE, IL 62918-1058
(618) 713-6286
(618) 985-4636

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Enumeration date
03/31/2010
Last updated
03/31/2010
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