Provider First Line Business Practice Location Address:
BERNARD A. MITCHELL HOSPITAL SB-TE058
Provider Second Line Business Practice Location Address:
FLOOR SB-TE058, 5835 S COTTAGE GROVE AVENUE
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-834-2433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2020