Provider First Line Business Practice Location Address:
3115 N HARLEM
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-889-0355
Provider Business Practice Location Address Fax Number:
773-889-0803
Provider Enumeration Date:
07/12/2006