Provider First Line Business Practice Location Address:
2233 W DIVISION ST. HOSPITALIST OFFICE-ROOM 111W
Provider Second Line Business Practice Location Address:
ST. MARY AND ELIZABETH 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:
60622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-770-2128
Provider Business Practice Location Address Fax Number:
773-728-5134
Provider Enumeration Date:
05/02/2009