| NPI | LastName | FirstName | MidName | Organization | Mailing Address | City | State | Zip |
| 1306879010 | DORIA | MANUEL | I | 530 NE GLEN OAK AVE | PEORIA | IL | 616370001 | |
| 1225053754 | HAYES | MICHAEL | P | 530 NE GLEN OAK AVE | PEORIA | IL | 616370001 | |
| 1730104258 | NIXON | JOHN | B | 530 NE GLEN OAK AVE | PEORIA | IL | 61637 | |
| 1750314472 | NULL | WILLIAM | 530 NE GLEN OAK AVE | PEORIA | IL | 616375763 |