Provider First Line Business Practice Location Address:
IL MASONIC MEDICAL CENTER, BEHAVIORAL HEALTH
Provider Second Line Business Practice Location Address:
938 W. NELSON, 3RD FLOOR, DEAF PROGRAM
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-296-3297
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2007