Provider First Line Business Practice Location Address:
2218 S. MICHIGAN AVE
Provider Second Line Business Practice Location Address:
SMG LAKESIDE MEDICAL CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-2189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-842-2082
Provider Business Practice Location Address Fax Number:
312-842-2214
Provider Enumeration Date:
12/19/2006