| NPI | LastName | FirstName | MidName | Organization | Mailing Address | City | State | Zip |
| 1609815992 | JAK ENTERPRISES INC | 8309 N KNOXVILLE AVE | PEORIA | IL | 616152170 | |||
| 1952427262 | LANE | STEVEN | H | 8309 N KNOXVILLE AVE | PEORIA | IL | 616152170 | |
| 1407901051 | TWENHAFEL | STACY | ANNE | 8309 N KNOXVILLE AVE | PEORIA | IL | 616152170 |