THOMAS P COSTELLO DO

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****12

NOT RENEWED

N

THOMAS P

COSTELLO

DO

THOMAS P COSTELLO DO

01/12/1987

01/12/1987

07/31/1987

CHICAGO

IL

60615

COOK

II III IV V

N

09/26/2006