Provider First Line Business Practice Location Address:
2300 N EDWARD ST
Provider Second Line Business Practice Location Address:
DECATUR MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-855-6039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2008