Provider First Line Business Practice Location Address:
707 N LOGAN AVE
Provider Second Line Business Practice Location Address:
DANVILLE POLYCLINIC, LTD.
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832-4360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-442-4186
Provider Business Practice Location Address Fax Number:
217-442-8336
Provider Enumeration Date:
08/31/2006