ALEXANDRE DEREVIANKO

GREAT LAKES, IL
NPI1679987879
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy246ZC0007X Specialist/Technologist, Other Surgical Assistant
(Licence: IL  238000408)
Enumeration Date2014-06-16
Last Update Date2014-06-19
Business Address
ALEXANDRE DEREVIANKO
1811 ARKANSAS AVE
GREAT LAKES, IL 60088-4244
Phone number: 401-480-9807
Mailing Address
ALEXANDRE DEREVIANKO
1811 ARKANSAS AVE
GREAT LAKES, IL 60088-4244
Phone number: 401-480-9807