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Individual

DEEANN MARIE TATE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
RR 1 BOX 47A, DALLAS CITY, IL 62330-9611
(309) 337-4629
(217) 852-9919
Mailing address
RR 1 BOX 47A, DALLAS CITY, IL 62330-9611
(309) 337-4629
(217) 852-9919

Taxonomy

Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
T30017377621
IL

Other

Enumeration date
04/11/2008
Last updated
04/11/2008
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