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Individual

JERRY GONZALEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1222 NORTH AVE, WAUKEGAN, IL 60085-2942
(847) 980-2410
Mailing address
1222 NORTH AVE, WAUKEGAN, IL 60085-2942
(847) 980-2410

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
45-3068110
IL

Other

Enumeration date
09/19/2015
Last updated
09/19/2015
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