Individual
GLORIA M ROSENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
411 S LINCOLN AVE, KANKAKEE, IL 60901-5529
(815) 939-7911
Mailing address
411 S LINCOLN AVE, KANKAKEE, IL 60901-5529
(815) 939-7911
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
R25316054101
IL
172A00000X
Driver
R25329365864
IL
Other
Enumeration date
08/11/2015
Last updated
08/11/2015
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