Provider First Line Business Practice Location Address:
1813 W. KIRBY AVENUE
Provider Second Line Business Practice Location Address:
PSYCHIATRY/PSYCHOLOGY
Provider Business Practice Location Address City Name:
CHAMPAIGN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-383-1850
Provider Business Practice Location Address Fax Number:
217-383-3439
Provider Enumeration Date:
05/17/2007