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1649652165
JACKIE TA
CHICAGO, IL
NPI
1649652165
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207L00000X Anesthesiology
(Licence: IL 125067630)
Enumeration Date
2015-06-20
Last Update Date
2015-06-20
Business Address
-- JACKIE TA D.O
1653 W CONGRESS PKWY
CHICAGO, IL 60612-3833
Phone number: 703-342-9546
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Mailing Address
-- JACKIE TA D.O
1653 W CONGRESS PKWY
CHICAGO, IL 60612-3833
Phone number: 703-342-9546
Copy
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