Individual
JORGE VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
502 S MORRIS AVE, BLOOMINGTON, IL 61701-4884
(309) 820-7616
Mailing address
204 W MAIN ST, DANVERS, IL 61732-9267
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/16/2024
Last updated
04/16/2024
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