Individual
KROSS WORRELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
750 BROADWAY AVE E, MATTOON, IL 61938-4610
(217) 238-5735
Mailing address
750 BROADWAY AVE E, MATTOON, IL 61938-4610
(217) 238-5735
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/18/2023
Last updated
07/18/2023
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