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115 E Walnut St Fairbury IL 61739-1516 | |
(815) 692-2305 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 115 E Walnut St, Fairbury, Illinois |
Authorized Official Name and Position | William Brouwer (PRESIDENT) |
Authorized Official Contact | 3092682129 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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115 E Walnut St Fairbury IL 61739-1516 Ph: (815) 692-2305 | 115 E Walnut St Fairbury IL 61739-1516 Ph: (815) 692-2305 |
NPI Number | 1487731220 |
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Provider Enumeration Date | 11/01/2006 |
Last Update Date | 04/20/2008 |
Identifier | Type | State | Issuer |
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1487731220 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |