Provider First Line Business Practice Location Address:
EDW HINES VA HOSPITAL, MENTAL HEALTH CLINIC
Provider Second Line Business Practice Location Address:
#116
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:
708-202-2109
Provider Business Practice Location Address Fax Number:
708-202-2108
Provider Enumeration Date:
06/12/2006