Provider First Line Business Practice Location Address:
CALIFORNIA AVE 15TH STREET
Provider Second Line Business Practice Location Address:
DEPT OF MEDICINE
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-1797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-257-6552
Provider Business Practice Location Address Fax Number:
773-257-6027
Provider Enumeration Date:
07/05/2005