Provider First Line Business Practice Location Address:
507 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-344-4722
Provider Business Practice Location Address Fax Number:
217-344-4733
Provider Enumeration Date:
10/03/2006