Provider First Line Business Practice Location Address:
UNIVERSITY OF ILLINOIS AT CHICAGO
Provider Second Line Business Practice Location Address:
801 S PAULINA STREET, MC 838
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-7213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-1105
Provider Business Practice Location Address Fax Number:
312-355-2688
Provider Enumeration Date:
05/18/2006