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1073753125
TEJUANA GROOMS
CHICAGO, IL
NPI
1073753125
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: IL 085.003340)
Enumeration Date
2009-03-03
Last Update Date
2012-03-30
Business Address
-- TEJUANA GROOMS PA-C
1901 W HARRISON ST FANTUS FAMILY PLANNING CLINIC 4TH FLOOR
CHICAGO, IL 60612-3714
Phone number: 708-945-9206
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Mailing Address
-- TEJUANA GROOMS PA-C
1901 W HARRISON ST FANTUS FAMILY PLANNING CLINIC 4TH FLOOR
CHICAGO, IL 60612-3714
Phone number: 708-945-9206
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