Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2008-10-07
- Last updated
- 2008-10-07
Specialties
Licenses
- License IL
- 0048223
Location
- Practice location
- 310 S EADS AVE
- City
- PARIS IL
- Postal code
- 619441938
- Phone
- 217-465-5395
Organization contact
- Name
- MARK PETERSEN
- Title
- President
- Phone
- 3096918113
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.