Provider First Line Business Practice Location Address:
1610 W 63RD ST
Provider Second Line Business Practice Location Address:
SOUTHPOINT 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:
60636-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-436-1770
Provider Business Practice Location Address Fax Number:
773-434-1770
Provider Enumeration Date:
10/17/2007