Provider First Line Business Practice Location Address:
500 EAST 51ST STREET
Provider Second Line Business Practice Location Address:
PROVIDENT HOSPITAL OF COOK COUNTY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60615-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-572-1200
Provider Business Practice Location Address Fax Number:
312-572-1294
Provider Enumeration Date:
10/03/2006