Provider First Line Business Practice Location Address:
211 E CHICAGO AVE STE 740
Provider Second Line Business Practice Location Address:
LAKESHORE NEUROLOGY LTD
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-943-1340
Provider Business Practice Location Address Fax Number:
312-943-1089
Provider Enumeration Date:
07/01/2005