Provider First Line Business Practice Location Address:
2800 COLLEGE AVE. SIU SCHOOL OF DENTISTRY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62002-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-474-7000
Provider Business Practice Location Address Fax Number:
618-474-7140
Provider Enumeration Date:
12/27/2006