Provider First Line Business Practice Location Address:
1212 N. LASALLE
Provider Second Line Business Practice Location Address:
STE 100/ SURGERY CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-943-7246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2019