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1215919816
TERRY ROTH
ROCKFORD, IL
NPI
1215919816
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2084N0400X Psychiatry & Neurology, Neurology
(Licence: IL 36059503)
Enumeration Date
2005-11-18
Last Update Date
2008-05-22
Business Address
-- TERRY ROTH
4920 EAST STATE ST
ROCKFORD, IL 61108
Phone number: 815-226-1906
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Mailing Address
-- TERRY ROTH
4920 EAST STATE ST
ROCKFORD, IL 61108
Phone number: 815-226-1906
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