Individual
MR. EMANUEL AGOSTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6109 W BARRY AVE, CHICAGO, IL 60634-4030
(773) 370-2266
Mailing address
6109 W BARRY AVE, CHICAGO, IL 60634-4030
(773) 370-2266
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
A22321075177
IL
Other
Enumeration date
04/25/2016
Last updated
04/25/2016
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