Provider First Line Business Practice Location Address:
DIVISION ST AND ROUTE 53
Provider Second Line Business Practice Location Address:
STATEVILLE CORRECTION CENTER
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60434-0112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-727-3607
Provider Business Practice Location Address Fax Number:
815-722-7039
Provider Enumeration Date:
02/08/2008