Provider First Line Business Practice Location Address:
602 W UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SC-2
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61801-2530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-383-3302
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2008