Provider First Line Business Practice Location Address:
2231 E. 95TH STREET
Provider Second Line Business Practice Location Address:
JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH CHICAGO, LLC
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60617-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-768-7700
Provider Business Practice Location Address Fax Number:
773-768-7768
Provider Enumeration Date:
07/28/2006