Provider First Line Business Practice Location Address:
1611 W HARRISON ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-4861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-243-4244
Provider Business Practice Location Address Fax Number:
312-942-1517
Provider Enumeration Date:
08/01/2006