Provider First Line Business Practice Location Address:
UNIVERSITY OF ILLINOIS - COLLEGE OF MEDICINE
Provider Second Line Business Practice Location Address:
1405 W PARK SUITE 207
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-333-7237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006