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1114345584
DAVID TENNANT
PEORIA, IL
NPI
1114345584
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
207Q00000X Family Medicine
(Licence: IL 036144079)
Enumeration Date
2014-04-02
Last Update Date
2018-05-17
Business Address
DAVID TENNANT
5409 N KNOXVILLE AVE
PEORIA, IL 61614
Phone number: 309-691-1000
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Mailing Address
DAVID TENNANT
5409 N KNOXVILLE AVE
PEORIA, IL 61614-5069
Phone number: 309-691-1000
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