Provider First Line Business Practice Location Address:
3115 N HARLEM AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60634-4684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-836-9900
Provider Business Practice Location Address Fax Number:
773-836-9935
Provider Enumeration Date:
05/24/2005