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Individual

JON DIFATTA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
214 N MAIN ST, ALGONQUIN, IL 60102-2449
(847) 854-4333
(847) 854-4334
Mailing address
214 N MAIN ST, ALGONQUIN, IL 60102-2449
(847) 854-4333
(847) 854-4334

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
178.006488
IL

Other

Enumeration date
02/20/2014
Last updated
02/20/2014
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