Provider First Line Business Practice Location Address:
839 ROUTE 24, WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT STERLING
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-773-3213
Provider Business Practice Location Address Fax Number:
217-773-3929
Provider Enumeration Date:
08/24/2006