Provider First Line Business Practice Location Address:
835 S. WOLCOTT AVE E-144
Provider Second Line Business Practice Location Address:
UNIVERSITY OF ILLINOIS MEDICAL CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-4006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-413-0369
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2010