Provider First Line Business Practice Location Address:
145 W DES PLAINES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COAL CITY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60416-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-212-2384
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2026