EDWAED WELDON FOWLER

CHICAGO, IL
NPI1508987355
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: IL  085000518)
Enumeration Date2007-04-02
Last Update Date2007-07-08
Business Address
-- EDWAED WELDON FOWLER pac
1901 W HARRISON ST
CHICAGO, IL 60612-3714
Phone number: 773-869-7488
Mailing Address
-- EDWAED WELDON FOWLER pac
1122 NEWBERRY AVE
LA GRANGE PARK, IL 60526-1249
Phone number: 708-415-0035
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