Provider First Line Business Practice Location Address:
600 LINCOLN AVE
Provider Second Line Business Practice Location Address:
EASTERN ILLINOIS UNIVERSITY ATHLETIC TRAINING
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61920-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-581-3811
Provider Business Practice Location Address Fax Number:
217-581-8300
Provider Enumeration Date:
10/11/2012