CLINTON LARISCY

GREAT LAKES, IL
NPI1164736302
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date2010-07-29
Last Update Date2010-07-29
Business Address
-- CLINTON LARISCY IDC
3355 ILLINOIS ST RECRUIT TRAINING COMMAND GREAT LAKES
GREAT LAKES, IL 60088
Phone number: 847-688-4643
Mailing Address
-- CLINTON LARISCY IDC
3355 ILLINOIS ST RECRUIT TRAINING COMMAND GREAT LAKES
GREAT LAKES, IL 60088
Phone number:
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