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MR. DALE FORREST GROOMS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
385 WINNETKA AVE, WINNETKA, IL 60093-4238
(847) 501-6445
(847) 446-8247
Mailing address
385 WINNETKA AVE, WINNETKA, IL 60093-4238
(847) 501-6445
(847) 446-8247

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
96000739
IL

Other

Enumeration date
11/03/2006
Last updated
07/08/2007
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