Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jun 24, 2011
License(s)
036133676 (IL), 125059830 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 611 W. PARK ST. BWPC | Urbana, IL 61801-2500 | 217-383-6792 |
| LOCATION | 611 W. PARK ST. | Urbana, IL 61801-2500 | 217-383-3311 |
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