Provider First Line Business Practice Location Address:
16B PROFESSIONAL PARK DR
Provider Second Line Business Practice Location Address:
LIN PAIN CLINIC, LTD
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-288-0879
Provider Business Practice Location Address Fax Number:
618-288-3351
Provider Enumeration Date:
01/25/2006