Provider First Line Business Practice Location Address:
333 S STATE ST
Provider Second Line Business Practice Location Address:
REVENUE #200 CHICAGO DEPARTMENT OF PUBLIC HEALTH
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-747-9442
Provider Business Practice Location Address Fax Number:
312-747-9447
Provider Enumeration Date:
10/24/2006