MS. Telisa Long
NPI #1285866111 in Park Forest, Illinois
Provider Information
- NPI Number
- 1285866111
- Entity Type
- Individual
- Name
- MS. Telisa Long
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Private Vehicle
- Enumeration Date
- Aug 11, 2009
- Last Updated
- Aug 11, 2009
Practice Location
- Address
- 413 INDIANWOOD BLVD
- City
- Park Forest
- State
- Illinois
- ZIP Code
- 60466-2247
- Phone
- (708) 369-2368
Specialties & Taxonomy Codes
| Specialty |
|---|
| Private Vehicle |
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