Provider First Line Business Practice Location Address:
416 NORTH 12TH STREET
Provider Second Line Business Practice Location Address:
SOUTHERN ILLINOIS CONSULTANTS FOR KIDNEY DISEASE, S.C.
Provider Business Practice Location Address City Name:
MT. VERNON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62864-4314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-244-4850
Provider Business Practice Location Address Fax Number:
618-244-7985
Provider Enumeration Date:
07/28/2005