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1235824418
JACOB WINGATE
PEORIA, IL
NPI
1235824418
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2023-04-05
Last Update Date
2023-04-05
Business Address
JACOB WINGATE DO
530 NE GLEN OAK AVE
PEORIA, IL 61637-0001
Phone number: 309-655-2109
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Mailing Address
JACOB WINGATE DO
530 NE GLEN OAK AVE
PEORIA, IL 61637-0001
Phone number: 309-655-2109
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