Provider First Line Business Practice Location Address:
500 W COURT STREET
Provider Second Line Business Practice Location Address:
PROVENA ST MARYS HOSPITAL WOUND HEALING SERVICES
Provider Business Practice Location Address City Name:
KANKAKEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-937-2273
Provider Business Practice Location Address Fax Number:
815-937-2280
Provider Enumeration Date:
10/23/2006