Provider First Line Business Practice Location Address:
130 E CLARK ST
Provider Second Line Business Practice Location Address:
SPECIALISTS CLINIC
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62946-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-252-1722
Provider Business Practice Location Address Fax Number:
618-252-1355
Provider Enumeration Date:
01/08/2007