Provider First Line Business Practice Location Address:
201 NORTH UNIVERSITY
Provider Second Line Business Practice Location Address:
ILLINOIS STATE STUDNET HEALTH SERVICES,
Provider Business Practice Location Address City Name:
NORMAL
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-438-8655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2016