ETHAN DWIGHT LANTZ

QUINCY, IL
NPI1518607423
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy103TC0700X Psychologist, Clinical
(Licence: IL  071.010740)
Enumeration Date2022-03-30
Last Update Date2022-03-30
Business Address
ETHAN DWIGHT LANTZ
6020 BROADWAY ST
QUINCY, IL 62305-7919
Phone number: 217-224-3366
Mailing Address
ETHAN DWIGHT LANTZ
6020 BROADWAY ST
QUINCY, IL 62305-7919
Phone number: 217-224-3366
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