Provider First Line Business Practice Location Address:
5301 E STATE ST
Provider Second Line Business Practice Location Address:
SUITE 101 BACK IN ACTION HOLISTIC HEALTH CENTER
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-397-8500
Provider Business Practice Location Address Fax Number:
815-397-8588
Provider Enumeration Date:
01/17/2007