| NPI | 1396923702 |
|---|---|
| Doing Business As | PROCTOR MEDICAL GROUP RENALDO JACQUES MD |
| Entity Type | Organization |
| Authorized Contact | CARRIE CHIARAVALLE Director Operations 309-689-6043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2008-02-07 |