Provider First Line Business Practice Location Address:
904 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62401-2193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-342-9558
Provider Business Practice Location Address Fax Number:
217-342-1049
Provider Enumeration Date:
03/27/2006