Organization
SPECTRUM SUPPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANIA BOON-RICHARDSON (OWNER)
(815) 404-3558
Entity
Organization
Contact information
Practice address
1575 WEST LAKE SHORE DRIVE, WOODSTOCK, IL 60098
(815) 404-3558
Mailing address
1575 WEST LAKE SHORE DRIVE, WOODSTOCK, IL 60098
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
03/17/2011
Last updated
03/17/2011
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