Provider First Line Business Practice Location Address:
1515 N MILWAUKEE AVE
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:
60622-8566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-772-2424
Provider Business Practice Location Address Fax Number:
773-772-2828
Provider Enumeration Date:
09/20/2005