Organization
WEST GRAND AVE. ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DORIS M LA SALVIA (PROPRIETOR)
(312) 455-2805
Entity
Organization
Contact information
Practice address
1855 W GRAND AVE, CHICAGO, IL 60622-6231
(312) 455-2805
(312) 455-2802
Mailing address
1855 W GRAND AVE, CHICAGO, IL 60622-6231
(312) 455-2805
(312) 455-2802
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/02/2009
Last updated
05/02/2009
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