Individual
BRANDON ANTHONY GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
5550 S UNIVERSITY AVE, CHICAGO, IL 60637-1522
(773) 702-1048
Mailing address
22939 S KATHEY DR, CHANNAHON, IL 60410-3239
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096002857
IL
Other
Enumeration date
11/09/2011
Last updated
11/10/2011
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