Individual
TONY PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2250 E WASHINGTON ST, EAST PEORIA, IL 61611-3021
(309) 643-1112
Mailing address
2250 E WASHINGTON ST, EAST PEORIA, IL 61611-3021
(309) 361-2959
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
11/16/2020
Last updated
11/16/2020
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