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PLC:4494
Agency:Champaign Urbana Public Health District
For:Clinic Fees
Phone:217-531-4263

Address:201 West Kenyon Road
Champaign, Illinois 61820

Please provide information about the payment you want to make and then click "Continue" to proceed.

*Required Fields
*Patient Name First:
Patient Name Middle:
*Patient Name Last:

*Payment Type:

*Patient #:
*Date of Visit: (mm/dd/yyyy)
*Phone #:
*Date of Birth: (mm/dd/yyyy)
Comments:

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