Provider First Line Business Practice Location Address:
734 W. 47TH STREET SOUTH
Provider Second Line Business Practice Location Address:
IHC
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-536-8400
Provider Business Practice Location Address Fax Number:
773-536-2406
Provider Enumeration Date:
08/08/2006