Provider First Line Business Practice Location Address:
2840 W FULLERTON AVE
Provider Second Line Business Practice Location Address:
LOGAN SQUARE HEALTH CENTER OF COOK COUNTY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60647-2938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-395-2966
Provider Business Practice Location Address Fax Number:
773-395-9608
Provider Enumeration Date:
08/14/2006