Wade Stark's National Provider Identifier (NPI) Details
Wade Stark,
NPI: 1801430988
Enumeration Date: 2019-11-01
Last updated: 2019-11-01
Sole Proprietor: NO
Status: active
Postal Address: 309 W CLARK ST, CHAMPAIGN, IL
Phone: 217-398-9066
Primary Practice Address: 309 W CLARK ST, CHAMPAIGN, IL
Practice's phone: 217-398-9066