Provider First Line Business Practice Location Address:
1000 HEALTH CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTOON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61938-4644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-238-4960
Provider Business Practice Location Address Fax Number:
217-238-4951
Provider Enumeration Date:
07/23/2006