Provider First Line Business Practice Location Address:
1925 N HARLEM AVE
Provider Second Line Business Practice Location Address:
#108
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60707-3743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-383-2191
Provider Business Practice Location Address Fax Number:
708-383-2509
Provider Enumeration Date:
07/25/2006