Provider First Line Business Practice Location Address:
1511 N BLACKHAWK BLVD
Provider Second Line Business Practice Location Address:
UNIVERSITY PRIMARY CARE CLINIC @ ROCKTON
Provider Business Practice Location Address City Name:
ROCKTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61072-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-624-2644
Provider Business Practice Location Address Fax Number:
815-624-2186
Provider Enumeration Date:
10/21/2005