Provider First Line Business Practice Location Address:
2525 S MICHIGAN AVE
Provider Second Line Business Practice Location Address:
DOCTORS OFFICE CENTER - 2ND FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-315-5115
Provider Business Practice Location Address Fax Number:
312-986-8694
Provider Enumeration Date:
01/28/2008