Provider First Line Business Practice Location Address:
5336 N WESTERN AVE
Provider Second Line Business Practice Location Address:
ATTN: LEONARD WEISS
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60625-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-271-5600
Provider Business Practice Location Address Fax Number:
773-271-2144
Provider Enumeration Date:
11/02/2005