Provider First Line Business Practice Location Address:
26TH STREET MEDICAL SERVICE COOP SC 3814 W 26TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-522-5200
Provider Business Practice Location Address Fax Number:
773-522-5356
Provider Enumeration Date:
02/21/2007