Organization
MSTOA STAFFING
Active
Other names
Moorish Science Temple of America
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATRICIA WALTONEL RMA (ASSISTANT MANAGER)
(773) 309-8749
Entity
Organization
Contact information
Practice address
353 S CICERO AVE, CHICAGO, IL 60644-4905
(773) 309-8749
Mailing address
353 S CICERO AVE, CHICAGO, IL 60644-4905
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
253Z00000X
IL
Other
Enumeration date
09/19/2011
Last updated
09/19/2011
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