Individual
LATOYIA SHUFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6433 S HERMITAGE AVE, CHICAGO, IL 60636-2705
(312) 718-2264
Mailing address
6433 S HERMITAGE AVE, CHICAGO, IL 60636-2705
(312) 718-2264
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
S16353683643
IL
Other
Enumeration date
07/13/2022
Last updated
07/13/2022
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