Provider First Line Business Practice Location Address:
374 E.GRAND AVE
Provider Second Line Business Practice Location Address:
SIUC STUDENT HEALTH CENTER
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-453-4346
Provider Business Practice Location Address Fax Number:
618-453-2347
Provider Enumeration Date:
01/19/2007