Provider First Line Business Practice Location Address:
111 S HALSTED ST
Provider Second Line Business Practice Location Address:
PHARMACY DEPT
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60661-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-463-9142
Provider Business Practice Location Address Fax Number:
312-463-9146
Provider Enumeration Date:
12/14/2011