Provider First Line Business Practice Location Address:
736 W 95TH ST
Provider Second Line Business Practice Location Address:
HALSTED MEDICAL CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60628-1063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-487-7700
Provider Business Practice Location Address Fax Number:
708-229-6077
Provider Enumeration Date:
01/05/2007