RANDY ALLAN BALLARD

CHAMPAIGN, IL
NPI1710375712
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IL  096.001564)
Enumeration Date2014-12-30
Last Update Date2014-12-30
Business Address
Mr. RANDY ALLAN BALLARD ATC
3112 VALERIE DR
CHAMPAIGN, IL 61822-1831
Phone number: 217-766-8137
Mailing Address
Mr. RANDY ALLAN BALLARD ATC
3112 VALERIE DR
CHAMPAIGN, IL 61822-1831
Phone number: 217-766-8137
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