Provider First Line Business Practice Location Address:
2800 COLLEGE AVE - BLDG. 263
Provider Second Line Business Practice Location Address:
SOUTHERN ILLINOIS UNIVERSITY, SCHOOL OF DENTAL MEDICINE
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:
618-474-7072
Provider Business Practice Location Address Fax Number:
618-474-7141
Provider Enumeration Date:
07/10/2013