Provider First Line Business Practice Location Address:
7144 N HARLEM AVE
Provider Second Line Business Practice Location Address:
SUITE 129
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60631-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-860-3244
Provider Business Practice Location Address Fax Number:
773-774-3244
Provider Enumeration Date:
04/12/2013