Provider First Line Business Practice Location Address:
HINES VA HOSPITAL
Provider Second Line Business Practice Location Address:
MENTAL HEALTH CLINIC (116A3)
Provider Business Practice Location Address City Name:
HINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-202-4658
Provider Business Practice Location Address Fax Number:
708-202-2108
Provider Enumeration Date:
10/10/2006