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1518354331
LISA TAMAR PROVORNY
CHICAGO, IL
NPI
1518354331
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
(Licence: IL 180011361)
Enumeration Date
2015-04-20
Last Update Date
2022-05-20
Business Address
LISA TAMAR PROVORNY L.C.P.C.
3320 W FOSTER AVE # 124
CHICAGO, IL 60625-4813
Phone number: 773-645-1443
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Mailing Address
LISA TAMAR PROVORNY L.C.P.C.
3320 W FOSTER AVE # 124
CHICAGO, IL 60625-4813
Phone number: 773-645-1443
Copy
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