Individual
DR. BRADLEY WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 N MAIN ST, ATHENS, IL 62613-8901
(217) 636-7388
Mailing address
PO BOX 65, ATHENS, IL 62613-0065
Taxonomy
Speciality
Code
Description
License number
State
174M00000X
Veterinarian
Primary
090008708
IL
Other
Enumeration date
05/15/2014
Last updated
05/15/2014
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