Provider First Line Business Practice Location Address:
111 SPRING ST
Provider Second Line Business Practice Location Address:
ST. MARY'S HOSPITAL
Provider Business Practice Location Address City Name:
STREATOR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61364-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-673-4566
Provider Business Practice Location Address Fax Number:
815-673-4683
Provider Enumeration Date:
04/02/2007