Provider Information for 1235574104
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REGINA THOMAS
Sex: Female
NPI: 1235574104
Last Updated: 2013-05-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1235574104 | ||||||||||||
| Enumeration Date | 2013-05-06 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 110 FRIARS CT BOLINGBROOK, IL 60440-2007 United States Phone: 630-729-4012 | Fax:630-972-0422 | ||||||||||||
| Primary Practice Address | 110 FRIARS CT BOLINGBROOK, IL 60440-2007 United States Phone: 630-729-4012 | Fax:630-972-0422 | ||||||||||||
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