Provider First Line Business Practice Location Address:
PROVIDENT HOSPITAL
Provider Second Line Business Practice Location Address:
500 . 51 STREET
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60615-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-572-2387
Provider Business Practice Location Address Fax Number:
312-572-5902
Provider Enumeration Date:
10/03/2006