Provider First Line Business Practice Location Address:
3303 LOGAN DRIVE
Provider Second Line Business Practice Location Address:
REA CLINIC HERRIN
Provider Business Practice Location Address City Name:
HERRIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-993-5767
Provider Business Practice Location Address Fax Number:
618-993-4005
Provider Enumeration Date:
09/25/2006