Individual
MS. MIMI MARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.T.
Contact information
Practice address
120 S MAIN ST, FARMER CITY, IL 61842-1454
(309) 824-4373
Mailing address
314 WASHINGTON ST, FARMER CITY, IL 61842-1346
(309) 928-9531
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
227.005957
IL
Other
Enumeration date
04/30/2008
Last updated
04/30/2008
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