Provider First Line Business Practice Location Address:
1531 E HYDE PARK BLVD
Provider Second Line Business Practice Location Address:
UNIVERSITY OF CHICAGO HOSPITALS LAKE PARK DIALYSIS UNIT
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60615-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-702-4548
Provider Business Practice Location Address Fax Number:
773-702-3565
Provider Enumeration Date:
10/10/2006