Provider First Line Business Practice Location Address:
2000 N NEIL ST
Provider Second Line Business Practice Location Address:
MARKET PLACE S/C
Provider Business Practice Location Address City Name:
CHAMPAIGN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61820-7808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-356-8585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2007