Individual
MRS. DARLA LYNN BLACKBOURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DTV
Contact information
Practice address
245 W EXCHANGE ST STE 4, SYCAMORE, IL 60178-1495
(815) 762-5129
Mailing address
245 W EXCHANGE ST STE 4, SYCAMORE, IL 60178-1495
(815) 762-5129
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
DM02390599P
IL
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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