Provider First Line Business Practice Location Address:
2300 N. EDWARD STREET
Provider Second Line Business Practice Location Address:
CIHA
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-876-6438
Provider Business Practice Location Address Fax Number:
217-876-6485
Provider Enumeration Date:
11/02/2017