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1932172087
CLAYTON A. CORLESS
ROCKFORD, IL
NPI
1932172087
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IL 0096-000784)
Enumeration Date
2006-02-09
Last Update Date
2007-07-08
Business Address
-- CLAYTON A. CORLESS ATC
5510 E STATE ST
ROCKFORD, IL 61108-2381
Phone number: 815-395-4505
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Mailing Address
-- CLAYTON A. CORLESS ATC
474 W EXCHANGE ST
SYCAMORE, IL 60178-1307
Phone number:
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