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Individual

LONNIE CRAWFORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1019 N MENARD AVE, CHICAGO, IL 60651-2665
(708) 506-0093
Mailing address
1019 N MENARD AVE, CHICAGO, IL 60651-2665
(708) 506-0093

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
C61652049205
IL

Other

Enumeration date
04/24/2018
Last updated
04/24/2018
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