Provider First Line Business Practice Location Address:
4839 WEST 47TH STREET
Provider Second Line Business Practice Location Address:
SOUTHWEST FAMILY HEALTH CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60638-2039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-735-2345
Provider Business Practice Location Address Fax Number:
773-581-1074
Provider Enumeration Date:
05/30/2007