Provider First Line Business Practice Location Address:
4239 S.ARCHER 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:
60632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-523-7527
Provider Business Practice Location Address Fax Number:
773-523-0609
Provider Enumeration Date:
09/14/2006