Provider First Line Business Practice Location Address:
500 SOUTH ART BARTELL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-384-3874
Provider Business Practice Location Address Fax Number:
217-337-0120
Provider Enumeration Date:
07/11/2005