Provider First Line Business Practice Location Address:
6505 W ARCHER AVENUE
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:
60638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-788-1566
Provider Business Practice Location Address Fax Number:
773-788-1567
Provider Enumeration Date:
04/11/2007