FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY

BLOOMINGTON, IL
NPI1902140585
Doing Business AsLIFERX
Entity TypeOrganization
Authorized ContactCLYDE L BASS
President
415-754-3379
Organization Subpart ?No
Primary Taxonomy207Q00000X Family Medicine
Enumeration Date2012-11-20
Last Update Date2016-09-21
Business Address
FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY
2412 E WASHINGTON ST STE 6
BLOOMINGTON, IL 61704-4497
Phone number: 309-585-2116
Mailing Address
FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY
612 E PERU ST
PRINCETON, IL 61356-1852
Phone number: 415-754-3379
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