Individual
MR. TOMMY BOHANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11417 N BOULDER CREEK CT, DUNLAP, IL 61525-1500
(309) 678-8081
Mailing address
11417 N BOULDER CREEK CT, DUNLAP, IL 61525-1500
(309) 678-8081
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/19/2016
Last updated
03/08/2016
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