Provider First Line Business Practice Location Address:
900 S CHESTNUT
Provider Second Line Business Practice Location Address:
PRAIRIE ROSE HEALTHCARE CENTER
Provider Business Practice Location Address City Name:
PANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-562-3996
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2008