Individual
MELVA ALICIA MCCORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3263 GREENLAKE DR, DECATUR, IL 62521-4830
(678) 614-4944
Mailing address
3263 GREENLAKE DR, DECATUR, IL 62521-4830
(678) 614-4944
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
M263-5416-1642
IL
Other
Enumeration date
02/14/2024
Last updated
02/14/2024
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