Provider First Line Business Practice Location Address:
4000 N ILLINOIS
Provider Second Line Business Practice Location Address:
TRI-LAB LLC @ ST ELIZABETH'S MEDICAL ARTS BUILD
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62226-1998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-233-8130
Provider Business Practice Location Address Fax Number:
618-236-9847
Provider Enumeration Date:
01/19/2006