Provider First Line Business Practice Location Address:
6349, N FAIRFIELD AVENUE
Provider Second Line Business Practice Location Address:
PRISM MEDICAL CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60659-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-262-1300
Provider Business Practice Location Address Fax Number:
773-262-1184
Provider Enumeration Date:
08/02/2005