Provider First Line Business Practice Location Address:
2001 W 69TH STREET
Provider Second Line Business Practice Location Address:
CLINIC PHARMACY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-778-2356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2006