Provider First Line Business Practice Location Address:
2929 S ELLIS AVE
Provider Second Line Business Practice Location Address:
ROTHSCHILD BASEMENT
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-3395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-791-3334
Provider Business Practice Location Address Fax Number:
312-791-3391
Provider Enumeration Date:
11/02/2006