Provider First Line Business Practice Location Address:
109 EAST MAPLE STREET
Provider Second Line Business Practice Location Address:
MAUCOUPIN COUNTY MAPLE STREET CLINIC
Provider Business Practice Location Address City Name:
GILLESPIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-839-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2016