Provider First Line Business Practice Location Address:
840 S. WOOD ST. UNIVERSITY OF ILLINOIS MEDICAL CENTER
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-7704
Provider Business Practice Location Address Fax Number:
312-413-8283
Provider Enumeration Date:
03/03/2011