Provider First Line Business Practice Location Address:
2620 N NARRAGANSETT AVE
Provider Second Line Business Practice Location Address:
SUITE B13
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60639-1081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-237-5265
Provider Business Practice Location Address Fax Number:
773-237-5385
Provider Enumeration Date:
03/21/2007