Provider First Line Business Practice Location Address:
1500 S. CALIFORNIA AVE.
Provider Second Line Business Practice Location Address:
MOUNT SINAI HOSPITAL, NR-513
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-1797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-257-4750
Provider Business Practice Location Address Fax Number:
773-257-4753
Provider Enumeration Date:
02/15/2013