Provider First Line Business Practice Location Address:
119 GAS PLANT RD
Provider Second Line Business Practice Location Address:
REA CLINIC DU QUOIN
Provider Business Practice Location Address City Name:
DU QUOIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-724-8702
Provider Business Practice Location Address Fax Number:
618-724-2571
Provider Enumeration Date:
10/05/2006