Provider First Line Business Practice Location Address:
1090 W MCKINLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62526-3208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-877-9351
Provider Business Practice Location Address Fax Number:
217-877-2137
Provider Enumeration Date:
03/20/2006