Provider First Line Business Practice Location Address:
5000 S. 5TH AVENUE
Provider Second Line Business Practice Location Address:
EDWARD J. HINES VA HOSPITAL
Provider Business Practice Location Address City Name:
HINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-202-4906
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2012