Provider First Line Business Practice Location Address:
1775 DEMPSTER ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PEDIATRICS-2 SOUTH BUILDING
Provider Business Practice Location Address City Name:
PARK RIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60068-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-723-6973
Provider Business Practice Location Address Fax Number:
847-723-2325
Provider Enumeration Date:
07/02/2006