Individual
FARON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
205 N REED ST, ROBINSON, IL 62454-1253
(618) 554-1574
Mailing address
205 N REED ST, ROBINSON, IL 62454-1253
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002204A
IN
Other
Enumeration date
12/17/2019
Last updated
12/17/2019
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