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2029 E 1850th St, Coatsburg, IL 62325-2102 | |
(217) 242-3164 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Dietitian, Registered |
Location | 2029 E 1850th St, Coatsburg, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
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1104944230 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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133V00000X | Dietitian, Registered | 164000168 (Illinois) | Primary |
Mailing Address | Practice Location Address |
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2029 E 1850th St, Coatsburg, IL 62325-2102 Ph: (217) 455-3491 | 2029 E 1850th St, Coatsburg, IL 62325-2102 Ph: (217) 242-3164 |