Provider First Line Business Practice Location Address:
122 SOUTH MICHIGAN AVE
Provider Second Line Business Practice Location Address:
SUITE 1311B
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-922-4418
Provider Business Practice Location Address Fax Number:
312-951-8861
Provider Enumeration Date:
11/16/2006