Provider First Line Business Practice Location Address:
1225 WEST LAKE ST
Provider Second Line Business Practice Location Address:
WEST LAKE HOSP
Provider Business Practice Location Address City Name:
MELROSE PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-938-7137
Provider Business Practice Location Address Fax Number:
708-938-7989
Provider Enumeration Date:
10/26/2006