Provider First Line Business Practice Location Address:
125 E. ADAMS ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CITY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-676-1532
Provider Business Practice Location Address Fax Number:
618-676-1404
Provider Enumeration Date:
08/29/2006