Provider First Line Business Practice Location Address:
815 ELM ST
Provider Second Line Business Practice Location Address:
FREDERICK BALL PUBLIC HOUSING
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62301-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-603-1460
Provider Business Practice Location Address Fax Number:
573-603-1462
Provider Enumeration Date:
02/02/2016