DOUGLAS M WALLEN

CHAMPAIGN, IL
NPI1407010176
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: IL  019020653)
Enumeration Date2008-07-11
Last Update Date2008-07-11
Business Address
-- DOUGLAS M WALLEN
2502 GALEN DR SUITE 103
CHAMPAIGN, IL 61821-7045
Phone number: 217-366-0050
Mailing Address
-- DOUGLAS M WALLEN
2502 GALEN DR SUITE 103
CHAMPAIGN, IL 61821-7045
Phone number: 217-366-0050
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