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Individual

MISS MICHELLE MARIE RADAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
L/PTA

Contact information

Practice address
1201 NEWCASTLE RD, WASHINGTON, IL 61571-1243
(309) 444-1065
(309) 444-1095
Mailing address
1201 NEWCASTLE RD, WASHINGTON, IL 61571-1243
(309) 444-1065
(309) 444-1095

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
160005261
IL

Other

Enumeration date
08/20/2010
Last updated
08/20/2010
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