Provider First Line Business Practice Location Address:
2520 N WASHTENAW AVE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60647-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-513-7720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007