Provider First Line Business Practice Location Address:
3115 N HARLEM AVE STE 300
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:
60634-4683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-283-2454
Provider Business Practice Location Address Fax Number:
773-283-2474
Provider Enumeration Date:
09/25/2006