Provider First Line Business Practice Location Address:
1220 S. WOOD STREET
Provider Second Line Business Practice Location Address:
UIH-MILE SQUARE HEALTH CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-413-1261
Provider Business Practice Location Address Fax Number:
312-413-7812
Provider Enumeration Date:
07/21/2006