Provider First Line Business Practice Location Address:
2300 N CHILDRENS PLZ
Provider Second Line Business Practice Location Address:
BOX 142
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-3363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-562-1240
Provider Business Practice Location Address Fax Number:
773-327-0547
Provider Enumeration Date:
11/16/2006