Provider First Line Business Practice Location Address:
801 S PAULINA STREET
Provider Second Line Business Practice Location Address:
DEPT OF ORAL MEDICINE UIC COLLEGE OF DENTISTRY 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:
312-996-1104
Provider Business Practice Location Address Fax Number:
312-996-9226
Provider Enumeration Date:
07/26/2006