Provider First Line Business Practice Location Address:
1200 N STADIUM DR
Provider Second Line Business Practice Location Address:
YORDON CENTER NORTHERN ILLINOIS UNIVERSITY SPORTS MEDIC
Provider Business Practice Location Address City Name:
DEKALB
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60115-6079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-762-7240
Provider Business Practice Location Address Fax Number:
815-753-2415
Provider Enumeration Date:
02/02/2009