Provider First Line Business Practice Location Address:
3631 N HARLEM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60634-2237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-810-9966
Provider Business Practice Location Address Fax Number:
630-810-9596
Provider Enumeration Date:
11/01/2006