Provider First Line Business Practice Location Address:
3001 A 6TH ST BHC 237
Provider Second Line Business Practice Location Address:
NAVAL HOSPITAL GREAT LAKES- DENTAL DEPT.
Provider Business Practice Location Address City Name:
GREAT LAKES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-688-3331
Provider Business Practice Location Address Fax Number:
847-688-6259
Provider Enumeration Date:
10/02/2008