OMAR FONSECA

WOODSTOCK, IL
NPI1366101420
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: IL  160.009394)
Enumeration Date2021-12-15
Last Update Date2021-12-15
Business Address
OMAR FONSECA
2000 LAKE AVE
WOODSTOCK, IL 60098-7401
Phone number: 815-206-3388
Mailing Address
OMAR FONSECA
277 DEERPATH DR
GENOA CITY, WI 53128-2504
Phone number: