Individual
MS. THERESA M MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1400 SUNSET AVE, SUITE 5, WAUKEGAN, IL 60087-4806
(224) 730-9331
Mailing address
1400 SUNSET AVE, SUITE 5, WAUKEGAN, IL 60087-4806
(224) 730-9331
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
227-013352
IL
Other
Enumeration date
06/13/2014
Last updated
06/13/2014
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