Individual
BON GAMIAO PACIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4314 S WABASH AVE, CHICAGO, IL 60653-3119
(312) 953-1175
Mailing address
6700 S OGLESBY AVE, APT 1405, CHICAGO, IL 60649-1301
(312) 953-1175
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070.017680
IL
Other
Enumeration date
07/12/2012
Last updated
07/12/2012
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