TERRY ROTH

ROCKFORD, IL
NPI1215919816
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2084N0400X Psychiatry & Neurology, Neurology
(Licence: IL  36059503)
Enumeration Date2005-11-18
Last Update Date2008-05-22
Business Address
-- TERRY ROTH
4920 EAST STATE ST
ROCKFORD, IL 61108
Phone number: 815-226-1906
Mailing Address
-- TERRY ROTH
4920 EAST STATE ST
ROCKFORD, IL 61108
Phone number: 815-226-1906
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