Individual
OLIVIA BANIFAZL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2522 FOREST VIEW AVE, RIVER GROVE, IL 60171-1602
(312) 813-4465
Mailing address
2522 FOREST VIEW AVE, RIVER GROVE, IL 60171-1602
(312) 813-4465
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198.001652
IL
Other
Enumeration date
05/02/2024
Last updated
05/02/2024
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