Individual
TAMELRA POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2352 RIVA RIDGE RD, MONTGOMERY, IL 60538-3407
(630) 966-2012
(630) 966-2010
Mailing address
2352 RIVA RIDGE RD, MONTGOMERY, IL 60538-3407
(630) 966-2012
(630) 966-2010
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
462608967
IL
Other
Enumeration date
01/16/2014
Last updated
01/16/2014
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