COSTA PROVIS

CHICAGO, IL
NPI1679767826
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YP2500X Counselor, Professional
(Licence: IL  180005903)
Enumeration Date2007-08-30
Last Update Date2007-08-30
Business Address
Mr. COSTA PROVIS L.C.P.C.
444 N MICHIGAN AVE
CHICAGO, IL 60611-3903
Phone number: 847-529-8607
Mailing Address
Mr. COSTA PROVIS L.C.P.C.
9430 OZARK AVE
MORTON GROVE, IL 60053-1063
Phone number: 847-529-8607
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