Provider First Line Business Practice Location Address:
912 S. WOOD STR
Provider Second Line Business Practice Location Address:
DEPARTMENT OF NEUROSURGERY MC 799
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-4842
Provider Business Practice Location Address Fax Number:
312-996-9018
Provider Enumeration Date:
09/05/2006