Provider First Line Business Practice Location Address:
215 N COURT ST
Provider Second Line Business Practice Location Address:
COURT STREET UNITED METHODIST CHURCH
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61103-6802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-391-1000
Provider Business Practice Location Address Fax Number:
815-484-8640
Provider Enumeration Date:
12/20/2005