JERRY L. SULLIVAN

SPRINGFIELD, IL
NPI1306909551
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IL  096.000548)
Enumeration Date2006-12-19
Last Update Date2007-07-08
Business Address
Mr. JERRY L. SULLIVAN Atc
3631 S. SIXTH STREET
SPRINGFIELD, IL 62703
Phone number: 217-341-4955
Mailing Address
Mr. JERRY L. SULLIVAN Atc
706 E ASH ST
TAYLORVILLE, IL 62568-1657
Phone number: 217-824-2863
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