Provider First Line Business Practice Location Address:
1326 S AVERS AVE
Provider Second Line Business Practice Location Address:
ERIE-HENSON HEALTH CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60623-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-565-6903
Provider Business Practice Location Address Fax Number:
773-565-6906
Provider Enumeration Date:
04/22/2008