TERRY J SUPAN

SPRINGFIELD, IL
NPI1366461410
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy222Z00000X Orthotist
(Licence: IL  213000001)
Additional Taxonomies224P00000X Prosthetist
(Licence: IL  211000002)
Enumeration Date2006-07-19
Last Update Date2007-07-08
Business Address
Mr. TERRY J SUPAN CPO
355 W CARPENTER STREET SUITE B
SPRINGFIELD, IL 62702-4945
Phone number: 217-789-1450
Mailing Address
Mr. TERRY J SUPAN CPO
355 W CARPENTER STREET SUITE B
SPRINGFIELD, IL 62702-4945
Phone number: 217-789-1450
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