Provider First Line Business Practice Location Address:
3001A 6TH ST.
Provider Second Line Business Practice Location Address:
NAVAL HEALTH CLINIC
Provider Business Practice Location Address City Name:
GREAT LAKES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60088-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-688-4723
Provider Business Practice Location Address Fax Number:
847-688-2066
Provider Enumeration Date:
02/12/2007