KIM KEITH WIESE

PEORIA, IL
NPI1801866744
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: IL  085.006503)
Enumeration Date2006-01-24
Last Update Date2020-05-19
Business Address
Mr. KIM KEITH WIESE PA-C
1524 W GLEN AVE
PEORIA, IL 61614-4692
Phone number: 309-512-0902
Mailing Address
Mr. KIM KEITH WIESE PA-C
1524 W GLEN AVE
PEORIA, IL 61614-4692
Phone number: 309-512-0902
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