Provider First Line Business Practice Location Address:
420 E STATE ST
Provider Second Line Business Practice Location Address:
WINNEBAGO COUNTY JAIL
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61104-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-319-6634
Provider Business Practice Location Address Fax Number:
815-395-5644
Provider Enumeration Date:
10/19/2007