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1609974096
SHANTA D. MATTAI
PEORIA, IL
NPI
1609974096
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
2084N0400X Psychiatry & Neurology, Neurology
(Licence: IL 036-113175)
Enumeration Date
2006-09-20
Last Update Date
2007-07-14
Business Address
-- SHANTA D. MATTAI
100 NE RANDOLPH AVE
PEORIA, IL 61606-1919
Phone number: 309-624-8500
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Mailing Address
-- SHANTA D. MATTAI
100 NE RANDOLPH AVE
PEORIA, IL 61606-1919
Phone number: 309-624-8500
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