Provider First Line Business Practice Location Address:
833 SOUTH WOOD STREET, ROOM 164
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PHARMACY PRACTICE (MC 886)
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-7230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-0897
Provider Business Practice Location Address Fax Number:
312-996-0379
Provider Enumeration Date:
11/03/2006