Provider First Line Business Practice Location Address:
3426 W ARMITAGE 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:
60647-3720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-772-8770
Provider Business Practice Location Address Fax Number:
773-772-8770
Provider Enumeration Date:
11/16/2006