| NPI | 1619682374 |
|---|---|
| Doing Business As | PEORIA |
| Entity Type | Organization |
| Authorized Contact | APRIL KING Credentialing Manager 469-221-5944 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2024-01-26 |