| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 3130 May Rd, Peru, Illinois |
| Authorized Official Name and Position | Colleen A Adams (BILLING MANAGER) |
| Authorized Official Contact | 6156618929 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 51525 Knoxville TN 37950-1525 Ph: (615) 661-8929 | 3130 May Rd Peru IL 61354-9618 Ph: (815) 224-7971 |
| NPI Number | 1891976296 |
|---|---|
| Provider Enumeration Date | 11/14/2007 |
| Last Update Date | 11/14/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891976296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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