Provider First Line Business Practice Location Address:
119 GAS PLANT ROAD
Provider Second Line Business Practice Location Address:
REA CLINIC-DUQUOIN
Provider Business Practice Location Address City Name:
DUQUOIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-542-8702
Provider Business Practice Location Address Fax Number:
618-542-8792
Provider Enumeration Date:
10/26/2007