Provider First Line Business Practice Location Address:
1330 W ARGYLE ST
Provider Second Line Business Practice Location Address:
UNIT 1-E
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60640-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-575-3399
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2007