Most Relevant Information
Provider Data
| NPI Number: | 1003475880 |
| Provider Name: | RALPH CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 172A00000X |
| Specialty: | Driver |
| License Number: | C46272064039 |
Most Important Dates
| Enumeration Date: | 06/06/2019 |
| Last Updated: | 06/06/2019 |
Provider Practice Location
14847 VAIL AVE
HARVEY
IL
604261536
Practice Location Phone/Fax
| Phone: | 7737249433 |
| Fax: |
Provider Mailing Location
12003 S PULASKI RD APT 256
ALSIP
IL
608031221
Provider Mailing Phone/Fax
| Phone: | 7086903845 |
| Fax: |