Provider First Line Business Practice Location Address:
102 W KENWOOD AVE
Provider Second Line Business Practice Location Address:
DECATUR MEMORIAL HOPSPITAL: KENWOOD MEDICAL CENTER
Provider Business Practice Location Address City Name:
DACATUR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62526-1046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-876-2690
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2006