Provider First Line Business Practice Location Address:
MEDICAL STAFF OFFICE, WEISS MEMORIAL HOSPITAL
Provider Second Line Business Practice Location Address:
4646 N MARINE DRIVE
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-564-5219
Provider Business Practice Location Address Fax Number:
773-564-5214
Provider Enumeration Date:
01/04/2019