Provider First Line Business Practice Location Address:
MC 275 1747 W ROOSEVELT RD
Provider Second Line Business Practice Location Address:
UNIVERSITY OF ILLINOIS AT CHICAGO WESTSIDE RESEARCH
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-355-3569
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2007