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1295218378
ALEXIS LOGAN
PEORIA, IL
NPI
1295218378
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: IL 085006727)
Enumeration Date
2018-09-13
Last Update Date
2018-09-13
Business Address
ALEXIS LOGAN
221 NE GLEN OAK AVE
PEORIA, IL 61636-0001
Phone number: 309-671-8297
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Mailing Address
ALEXIS LOGAN
221 NE GLEN OAK AVE
PEORIA, IL 61636-0001
Phone number: 309-671-8297
Copy
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