Provider First Line Business Practice Location Address:
801 S PAULINA ST
Provider Second Line Business Practice Location Address:
COLLEGE OF DENTISTRY; DEPT OMFS (MC 835)
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-7211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-355-2713
Provider Business Practice Location Address Fax Number:
312-996-7461
Provider Enumeration Date:
03/18/2009