Provider First Line Business Practice Location Address:
505 E GRANT ST
Provider Second Line Business Practice Location Address:
SUITE 110 FAMILY PRACTICE ASSOCIATES OF MACOMB LTD
Provider Business Practice Location Address City Name:
MACOMB
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61455-3352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-833-1733
Provider Business Practice Location Address Fax Number:
309-836-2369
Provider Enumeration Date:
12/09/2005