Provider First Line Business Practice Location Address:
5409 NORTH KNOXVILLE AVE.
Provider Second Line Business Practice Location Address:
PROCTOR HOSPITAL
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-691-1056
Provider Business Practice Location Address Fax Number:
309-689-6010
Provider Enumeration Date:
10/02/2006