Provider First Line Business Practice Location Address:
2530 N MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62526-3249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-875-0920
Provider Business Practice Location Address Fax Number:
217-876-9351
Provider Enumeration Date:
12/20/2005