Provider First Line Business Practice Location Address:
1900 WEST POLK STREET
Provider Second Line Business Practice Location Address:
SECTION OF DERMATOLOGY, ADMIN. BUILDING, 5TH FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-839-2429
Provider Business Practice Location Address Fax Number:
312-864-9663
Provider Enumeration Date:
11/03/2008