Provider First Line Business Practice Location Address:
467 W DEMING ST
Provider Second Line Business Practice Location Address:
LINCOLN PARK PRIMARY CARE
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-327-9125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2006