Individual
CAROL LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
603 W DELMAR AVE, ALTON, IL 62002-4277
(618) 467-0640
Mailing address
603 W DELMAR AVE, ALTON, IL 62002-4277
(618) 467-0640
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
03/09/2016
Last updated
03/09/2016
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