Graduated: 2022
NPI: 1962041293
Practice Locations (2)
LEGACY HEALTHCARE SERVICES INC
16 LILAC AVE
FOX LAKE, IL 600201803
8476290336
ATHLETIC AND THERAPEUTIC INSTITUTE OF BOURBONNAIS, LLC
11535 US HWY 14
WOODSTOCK, IL 600987227
8153627354
Source: CMS National Downloadable File, September 2026.