Provider First Line Business Practice Location Address:
3333 GREEN BAY ROAD
Provider Second Line Business Practice Location Address:
ATTN PSYCHIATRY DEPARTMENT
Provider Business Practice Location Address City Name:
NORTH CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-983-4262
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2008