Provider First Line Business Practice Location Address:
912 S WOOD STREET
Provider Second Line Business Practice Location Address:
DEPARTMENT OF NEUROLOGY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-6061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-843-0770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2005