Provider First Line Business Practice Location Address:
5145 N CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
NORTHSHORE MEDICAL GROUP
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60625-3661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-293-5486
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2010