Provider First Line Business Practice Location Address:
4630 SOUTH BISHOP STREET
Provider Second Line Business Practice Location Address:
UIH-MILE SQUARE HEALTH CENTER AT BACK OF THE YARDS
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60609-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-579-9401
Provider Business Practice Location Address Fax Number:
312-413-7812
Provider Enumeration Date:
04/01/2008