Provider First Line Business Practice Location Address:
1640 W. ROOSEVELT ROAD, (MC 727)
Provider Second Line Business Practice Location Address:
FAMILY CLINIC, DEPT. OF DISABILITY AND HUMAN DEVEL
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-6904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-419-2652
Provider Business Practice Location Address Fax Number:
312-413-1593
Provider Enumeration Date:
12/06/2012