Provider First Line Business Practice Location Address:
2406 E UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61802-6204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-384-2071
Provider Business Practice Location Address Fax Number:
217-384-2095
Provider Enumeration Date:
06/22/2005