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1568291268
RUSSELL EDAFETANURE-IBEH
CHICAGO, IL
NPI
1568291268
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2024-07-31
Last Update Date
2024-07-31
Business Address
RUSSELL EDAFETANURE-IBEH
1853 W POLK ST
CHICAGO, IL 60612-4355
Phone number: 312-996-5636
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Mailing Address
RUSSELL EDAFETANURE-IBEH
1853 W POLK ST
CHICAGO, IL 60612-4355
Phone number:
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