Individual
CORY EDWARD WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3624 W CASSADAGA CT, PEORIA, IL 61615-3952
(309) 922-9339
Mailing address
3624 W CASSADAGA CT, PEORIA, IL 61615-3952
(309) 922-9339
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
IL
Other
Enumeration date
07/07/2025
Last updated
07/07/2025
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