Registry details
Type
Individual
Primary specialty
Orthopaedic Surgery
Enumerated
Jun 30, 2010
License(s)
036144323 (IL), 036144323 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1303 W EVERGREEN AVE STE 200 | Effingham, IL 62401-1638 | 217-342-3400 |
| MAILING | PO BOX 372 | Mattoon, IL 61938-0372 |
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