Provider First Line Business Practice Location Address:
NORTHSHORE UNIVERSITY HEALTHSYSTEM, OFFICE OF ACADEMIC
Provider Second Line Business Practice Location Address:
AFFAIRS, 2650 RIDGE AVE., SUITE 1304
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-570-4789
Provider Business Practice Location Address Fax Number:
847-570-2905
Provider Enumeration Date:
07/17/2018