Provider First Line Business Practice Location Address:
1520 NORTH KOSTN
Provider Second Line Business Practice Location Address:
NEAR NORTH HEALTH CENTER -NORTH KOSTNER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-216-8020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2016