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1083187553
ACTIVE LIFE SPINE & JOINT CLINIC LLC
ROCKFORD, IL
NPI
1083187553
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Entity Type
Organization
Authorized Contact
RONALD SAMANIEGO
Owner
224-425-0548
Organization Subpart ?
No
Primary Taxonomy
225100000X Physical Therapist
Enumeration Date
2019-01-08
Last Update Date
2019-01-08
Business Address
ACTIVE LIFE SPINE & JOINT CLINIC LLC
3600 E STATE ST STE 222
ROCKFORD, IL 61108-1956
Phone number: 224-425-0548
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Mailing Address
ACTIVE LIFE SPINE & JOINT CLINIC LLC
3600 E STATE ST STE 222
ROCKFORD, IL 61108-1956
Phone number:
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