Individual
MR. DHAHABU MFALME HATARI OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
58 CAROLYN CT, SPRINGFIELD, IL 62702-1563
(217) 416-5214
Mailing address
58 CAROLYN CT, SPRINGFIELD, IL 62702-1563
(217) 416-5214
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
O52017376137
IL
Other
Enumeration date
11/23/2021
Last updated
11/23/2021
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