Provider First Line Business Practice Location Address:
303 NW 11TH ST.
Provider Second Line Business Practice Location Address:
FAIRFIELD MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-847-8298
Provider Business Practice Location Address Fax Number:
618-847-8274
Provider Enumeration Date:
09/19/2014