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1700899788
DONALD R. WALLACE
PEORIA, IL
NPI
1700899788
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207P00000X Emergency Medicine
(Licence: IL 036-077680)
Enumeration Date
2006-08-14
Last Update Date
2010-07-29
Business Address
-- DONALD R. WALLACE M.D.
5114 N GLEN PARK PLACE RD
PEORIA, IL 61614-4686
Phone number: 309-683-6600
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Mailing Address
-- DONALD R. WALLACE M.D.
5114 N GLEN PARK PLACE RD
PEORIA, IL 61614-4686
Phone number: 309-683-6600
Copy
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