Provider First Line Business Practice Location Address:
530 E 31ST ST
Provider Second Line Business Practice Location Address:
STD 31ST STREET CLINIC
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-4008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-747-9792
Provider Business Practice Location Address Fax Number:
312-747-9447
Provider Enumeration Date:
12/13/2006