Provider First Line Business Practice Location Address:
3420 ILLINOIS ST
Provider Second Line Business Practice Location Address:
AH14 MEDICAL CLINIC
Provider Business Practice Location Address City Name:
GREAT LAKES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60088-3161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-688-7406
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006