Provider First Line Business Practice Location Address:
45 W 111TH STREET
Provider Second Line Business Practice Location Address:
ROSELAND COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-995-3000
Provider Business Practice Location Address Fax Number:
630-734-1560
Provider Enumeration Date:
04/19/2006