Provider First Line Business Practice Location Address:
500 E. 51ST STREET
Provider Second Line Business Practice Location Address:
PROVIDENT HOSPITAL OF COOK COUNTY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-572-2680
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006