PONCIANO PORMENTIRA

FLORA, IL
NPI1548510357
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: IL  070.015245)
Enumeration Date2012-09-19
Last Update Date2012-09-19
Business Address
-- PONCIANO PORMENTIRA DPT
929 STACY BURK DRIVE
FLORA, IL 62839
Phone number: 618-662-8060
Mailing Address
-- PONCIANO PORMENTIRA DPT
124 E 4TH ST
FLORA, IL 62839-2009
Phone number:
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