Provider First Line Business Practice Location Address:
200 E MAIN ST
Provider Second Line Business Practice Location Address:
LIFEWAY BEHAVIORAL HEALTH SERVICES INC
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61727-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-935-3900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2012