Individual
JERMAINE DALE WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6833 S CLAREMONT AVE, CHICAGO, IL 60636-3138
(708) 368-7010
Mailing address
10812 S 76TH AVE APT 3S, WORTH, IL 60482-1061
(708) 985-6159
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
L34073286149
IL
Other
Enumeration date
01/18/2019
Last updated
01/18/2019
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