Individual
MARY KIENSTRA FRESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
2244 HENLEY ST, GLENVIEW, IL 60025-4162
(314) 448-9169
Mailing address
2244 HENLEY ST, GLENVIEW, IL 60025-4162
(314) 448-9169
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
IN PROGRESS
IL
Other
Enumeration date
04/23/2014
Last updated
04/23/2014
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