Provider First Line Business Practice Location Address:
28 CHICK ST
Provider Second Line Business Practice Location Address:
DECKER MEDICAL ANNEX
Provider Business Practice Location Address City Name:
METROPOLIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62960-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-524-9232
Provider Business Practice Location Address Fax Number:
618-524-9489
Provider Enumeration Date:
10/26/2005