Provider First Line Business Practice Location Address:
SOUTH SHORE HOSPITAL BUILDING
Provider Second Line Business Practice Location Address:
8015 SOUTH LUZELLA AVE
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-356-5406
Provider Business Practice Location Address Fax Number:
773-356-5440
Provider Enumeration Date:
12/19/2006