Provider First Line Business Practice Location Address:
3533 S ARCHER AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60609-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-847-4417
Provider Business Practice Location Address Fax Number:
773-847-4942
Provider Enumeration Date:
04/25/2007