Provider First Line Business Practice Location Address:
403 E. 1ST STREET
Provider Second Line Business Practice Location Address:
KATHERINE SHAW BETHEA HOSPITAL
Provider Business Practice Location Address City Name:
DIXON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-285-5629
Provider Business Practice Location Address Fax Number:
815-285-5634
Provider Enumeration Date:
05/03/2007