Provider First Line Business Practice Location Address:
225 EAST CHICAGO AVE.
Provider Second Line Business Practice Location Address:
DIVISION OF PEDIATRIC OPTHALMOLOGY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-543-7362
Provider Business Practice Location Address Fax Number:
312-227-9411
Provider Enumeration Date:
09/20/2005