Individual
MYCHELE LEA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
2732 75TH AVE, VIOLA, IL 61486-9555
(309) 737-4989
Mailing address
2732 75TH AVE, VIOLA, IL 61486-9555
(309) 737-4989
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Enumeration date
06/07/2006
Last updated
07/27/2007
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