Provider First Line Business Practice Location Address: 
CAPTAIN JAMES A. LOVELL FEDERAL HEALTH CARE CENTER
    Provider Second Line Business Practice Location Address: 
3001 GREEN BAY ROAD
    Provider Business Practice Location Address City Name: 
NORTH CHICAGO
    Provider Business Practice Location Address State Name: 
IL
    Provider Business Practice Location Address Postal Code: 
60064
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
224-610-7501
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
12/08/2014