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1710375712
RANDY ALLAN BALLARD
CHAMPAIGN, IL
NPI
1710375712
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IL 096.001564)
Enumeration Date
2014-12-30
Last Update Date
2014-12-30
Business Address
Mr. RANDY ALLAN BALLARD ATC
3112 VALERIE DR
CHAMPAIGN, IL 61822-1831
Phone number: 217-766-8137
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Mailing Address
Mr. RANDY ALLAN BALLARD ATC
3112 VALERIE DR
CHAMPAIGN, IL 61822-1831
Phone number: 217-766-8137
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