Provider First Line Business Practice Location Address:
4901 W 79TH. ST.
Provider Second Line Business Practice Location Address:
SUITE 5 MIDWAY INTERNAL MEDICINE S.C
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-952-4403
Provider Business Practice Location Address Fax Number:
708-952-4404
Provider Enumeration Date:
05/18/2006