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Organization · General Practice Physician · Peoria, IL

NPI

1912367582

Type

Organization (Type 2)

Primary specialty

General Practice Physician (General Practice)

Specialty group

Allopathic & Osteopathic Physicians

Taxonomy code

208D00000X

License number

036086752 (IL)

Enumerated

2016-02-25

Last updated

2016-04-04