Individual
CLARK ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
19010 AVERS AVE, FLOSSMOOR, IL 60422-1017
(708) 574-0728
Mailing address
19010 AVERS AVE, FLOSSMOOR, IL 60422-1017
(708) 574-0728
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
IL
Other
Enumeration date
04/10/2017
Last updated
04/10/2017
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