Provider First Line Business Practice Location Address:
2300 CHILDREN'S PLAZA BOX 93
Provider Second Line Business Practice Location Address:
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:
773-327-2440
Provider Business Practice Location Address Fax Number:
773-327-2510
Provider Enumeration Date:
08/19/2008