Provider First Line Business Practice Location Address:
616 S HIGHWAY 31
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MCHENRY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-344-6400
Provider Business Practice Location Address Fax Number:
815-344-8940
Provider Enumeration Date:
10/30/2006