Provider First Line Business Practice Location Address:
1600 NORTH BROADWAY
Provider Second Line Business Practice Location Address:
TWIN WILLOWS NURSING CENTER
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62881-0370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-548-0542
Provider Business Practice Location Address Fax Number:
618-548-3081
Provider Enumeration Date:
07/07/2006