Provider First Line Business Practice Location Address:
5TH AND ROOSEVELT AVE
Provider Second Line Business Practice Location Address:
HINES VA HOSPITAL M/C 119
Provider Business Practice Location Address City Name:
HINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-202-3780
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006