Provider First Line Business Practice Location Address:
5841 S MARYLAND AVE # MC0077
Provider Second Line Business Practice Location Address:
UNIVERSITY OF CHICAGO, DEPT OF HUMAN GENETICS
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60637-1447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-702-2079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2005