Individual
MADDISON VINYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2930 MONTVALE DR STE E, SPRINGFIELD, IL 62704-5376
(217) 717-4399
Mailing address
2244 S SPRING ST, SPRINGFIELD, IL 62704-4752
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/27/2024
Last updated
05/27/2024
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