Individual
MR. MFOMBU AYUKESONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
14828 ARTESIAN AVE, HARVEY, IL 60426-1313
(708) 566-4328
(708) 589-3372
Mailing address
PO BOX 44, POSEN, IL 60469-0044
(708) 566-4328
(708) 589-3372
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2380000263
IL
Other
Enumeration date
07/09/2010
Last updated
07/09/2010
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