Provider First Line Business Practice Location Address:
4900 N BERNARD ST
Provider Second Line Business Practice Location Address:
ATTN: LEONARD WEISS
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60625-5146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-583-7130
Provider Business Practice Location Address Fax Number:
773-583-3929
Provider Enumeration Date:
11/04/2005