Provider First Line Business Practice Location Address:
641 W. 63RD ST
Provider Second Line Business Practice Location Address:
UIH-MILE SQUARE HEALTH CENTER AT ENGLEWOOD
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60621-2032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-413-4070
Provider Business Practice Location Address Fax Number:
312-413-7812
Provider Enumeration Date:
07/27/2012