Provider First Line Business Practice Location Address:
637 SOUTH WOOD STREET ST 215
Provider Second Line Business Practice Location Address:
DIVISION OF NEPHROLOGY, DURAND BUILDING
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-864-4612
Provider Business Practice Location Address Fax Number:
312-864-9569
Provider Enumeration Date:
09/19/2008