Individual
CLARK ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1001 MAIN ST, SUITE 500A, PEORIA, IL 61606-1907
(309) 672-4980
(309) 671-2979
Mailing address
PO BOX 365, MORTON, IL 61550-0365
(309) 672-4980
(309) 671-2979
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002809
IL
Other
Enumeration date
11/03/2006
Last updated
12/10/2014
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