Provider First Line Business Practice Location Address:
101 W MCKINLEY AVE
Provider Second Line Business Practice Location Address:
ENTA ALLERGY, HEAD & NECK INSTITUTE
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-876-3682
Provider Business Practice Location Address Fax Number:
217-876-3345
Provider Enumeration Date:
04/27/2006