MYOFASCIAL RELEASE OF SOUTHERN ILLINOIS
Ambulatory Health at Graham Ave, Carbondale, IL

License number
Illinois 248.000873
Category
Ambulatory Health
Type
Rehabilitation
Owner
Name: TARA MANZANO OTR/L
Title: PRESIDENT/OCCUPATIONAL THERAPIST
Phone: (618) 305-4696
Address
Address
101 S Graham Ave SUITE 3, Carbondale, IL 62901
National Provider ID: 1851722946
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

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