Provider First Line Business Practice Location Address:
1600 DODGE AVE
Provider Second Line Business Practice Location Address:
SCHOOL BASED HEALTH CENTER, H101
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-3449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-424-7254
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006