Provider First Line Business Practice Location Address:
1069 W ARGYLE ST
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:
60640-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-728-7022
Provider Business Practice Location Address Fax Number:
773-989-9180
Provider Enumeration Date:
03/10/2007