Organization
WEST TOWN MEDICAL ASSOCIATES,SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIO LARA VALLE MD (PRESIDENT)
(312) 829-4636
Entity
Organization
Contact information
Practice address
1859 W CHICAGO AVE, CHICAGO, IL 60622-5513
(312) 829-4636
Mailing address
3 NORRIS DR, BURR RIDGE, IL 60527-5124
(630) 655-0544
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
—
IL
261Q00000X
Clinic/Center
—
IL
Other
Enumeration date
11/26/2007
Last updated
11/26/2007
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