Provider First Line Business Practice Location Address:
801 S MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
CONDELL MEDICAL CENTER
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60048-3199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-740-2296
Provider Business Practice Location Address Fax Number:
847-740-0125
Provider Enumeration Date:
11/06/2006