Provider First Line Business Practice Location Address:
201 EAST HURON RENAL CLINIC
Provider Second Line Business Practice Location Address:
NORTHWESTERN MEMORIAL HOSPITAL- GALTER BUILDING
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-695-0592
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2006