Provider First Line Business Practice Location Address:
CAMPUS BOX 7130 - HORTON FIELDHOUSE
Provider Second Line Business Practice Location Address:
ILLINOIS STATE UNIVERSITY
Provider Business Practice Location Address City Name:
NORMAL
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61790-7130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-438-7246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2006