Provider First Line Business Practice Location Address:
602 W UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR, SOUTH CLINIC BLDG.
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61801-2530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-383-3170
Provider Business Practice Location Address Fax Number:
217-326-1300
Provider Enumeration Date:
12/29/2010