Individual
ANTHONY LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
14011 KENTON AVE, CRESTWOOD, IL 60445-2252
(219) 794-4653
Mailing address
5750 ABBEY DR, APT 2C, LISLE, IL 60532-2582
(309) 721-6705
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
2000026450
IL
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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