Provider First Line Business Practice Location Address: 
UPTOWN NEIGHBORHOOD HEALTH CENTER
    Provider Second Line Business Practice Location Address: 
845 W WILSON
    Provider Business Practice Location Address City Name: 
CHICAGO
    Provider Business Practice Location Address State Name: 
IL
    Provider Business Practice Location Address Postal Code: 
60640
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
312-744-1938
    Provider Business Practice Location Address Fax Number: 
312-744-5023
    Provider Enumeration Date: 
08/15/2005