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1194826115
KENNETH FRASER
PEORIA, IL
NPI
1194826115
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2085R0202X Radiology, Diagnostic Radiology
(Licence: IL 088568)
Enumeration Date
2006-09-25
Last Update Date
2007-10-30
Business Address
-- KENNETH FRASER
411 HAMILTON BLVD 1824
PEORIA, IL 61602-1144
Phone number: 309-494-9320
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Mailing Address
-- KENNETH FRASER
10335 N PORT WASHINGTON RD SUITE 250
MEQUON, WI 53092-5763
Phone number:
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