Provider First Line Business Practice Location Address:
7334 S UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60619-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-256-7550
Provider Business Practice Location Address Fax Number:
562-256-7540
Provider Enumeration Date:
04/20/2012