Provider First Line Business Practice Location Address:
UIC PSYCHIATRY RESIDENCY 912 S. WOOD ST.
Provider Second Line Business Practice Location Address:
RM 130B NPI-S (MC 913)
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-4981
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2020