Provider First Line Business Practice Location Address:
2300 CHILDRENS PLAZA
Provider Second Line Business Practice Location Address:
BOX 30
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-3394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-868-8903
Provider Business Practice Location Address Fax Number:
773-868-8016
Provider Enumeration Date:
05/04/2006