| NPI | 1063178069 |
|---|---|
| Former Legal Business Name | THERESA D MOORE |
| Entity Type | Organization |
| Authorized Contact | THERESA DENISE MOORE Owner 773-587-8240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2021-11-14 |
| Last Update Date | 2021-11-14 |