Provider First Line Business Practice Location Address:
2160 S. FIRST AVENUE
Provider Second Line Business Practice Location Address:
LOYOLA UNIVERSITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
MAYWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60153-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-216-8757
Provider Business Practice Location Address Fax Number:
708-216-1259
Provider Enumeration Date:
05/01/2012