Provider First Line Business Practice Location Address:
1657 W ADAMS ST
Provider Second Line Business Practice Location Address:
GROUND FLOOR - DENTAL
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-738-0762
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2009