Provider First Line Business Practice Location Address:
407 W SPRINGFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61801-8809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-367-7546
Provider Business Practice Location Address Fax Number:
217-367-2240
Provider Enumeration Date:
06/08/2005