Provider First Line Business Practice Location Address:
2800 S CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
MED/SURG OFFICE
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-869-7488
Provider Business Practice Location Address Fax Number:
773-869-3578
Provider Enumeration Date:
10/04/2006