Provider First Line Business Practice Location Address:
2900 N. LAKE SHORE DRIVE
Provider Second Line Business Practice Location Address:
SAINT JOSEPH HOSPITAL
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-6274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-665-3069
Provider Business Practice Location Address Fax Number:
773-665-6231
Provider Enumeration Date:
02/25/2009