Provider First Line Business Practice Location Address:
2915 S ELLIS AVE
Provider Second Line Business Practice Location Address:
1ST FLR. KUNSTADTER CHILDRENS BUILDING ,MICHAEL REESE H
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-791-8002
Provider Business Practice Location Address Fax Number:
312-791-2093
Provider Enumeration Date:
04/12/2007