Individual
BAILEY R ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
380 N VAN BUREN AVE, BRADLEY, IL 60915-1486
(815) 953-1019
Mailing address
380 N VAN BUREN AVE, BRADLEY, IL 60915-1486
(815) 953-1019
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
2255A2300X
IL
Other
Enumeration date
01/08/2016
Last updated
01/08/2016
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