Organization
RADICAL ROOTS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA ALFORD APRN (OWNER)
(765) 267-1177
Entity
Organization
Contact information
Practice address
2046 JONATHAN CREEK RD, ARTHUR, IL 61911-6108
(765) 267-1177
Mailing address
2046 JONATHAN CREEK RD, ARTHUR, IL 61911-6108
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/13/2021
Last updated
05/30/2022
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