Provider First Line Business Practice Location Address:
1200 N 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62401-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-342-5502
Provider Business Practice Location Address Fax Number:
217-342-6971
Provider Enumeration Date:
08/02/2005