Provider First Line Business Practice Location Address:
801 S PAULINA ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ENDODONTICS
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-7210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-510-3619
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2008