Provider First Line Business Practice Location Address:
1969 W OGDEN AVE
Provider Second Line Business Practice Location Address:
DEPT. OF SURGERY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-3765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-9336
Provider Business Practice Location Address Fax Number:
312-355-3763
Provider Enumeration Date:
07/13/2006