Organization
DIVINE AESTHETICS MEDSPA & WELLNESS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANICKA WILLIAMS M.D. (OWNER)
(855) 276-5212
Entity
Organization
Contact information
Practice address
6810 S PAXTON AVE, CHICAGO, IL 60649-1603
(866) 834-8463
Mailing address
6810 S PAXTON AVE, CHICAGO, IL 60649-1603
(866) 834-8463
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.128645
IL
Other
Enumeration date
08/15/2013
Last updated
10/28/2013
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