Provider First Line Business Practice Location Address:
403 E 1ST ST
Provider Second Line Business Practice Location Address:
KSB HOSPITAL
Provider Business Practice Location Address City Name:
DIXON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61021-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-285-5830
Provider Business Practice Location Address Fax Number:
815-285-5592
Provider Enumeration Date:
04/04/2007