Provider First Line Business Practice Location Address: 
1301 S BARRINGTON RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BARRINGTON
    Provider Business Practice Location Address State Name: 
IL
    Provider Business Practice Location Address Postal Code: 
60010-5202
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
847-620-4574
    Provider Business Practice Location Address Fax Number: 
847-620-4575
    Provider Enumeration Date: 
05/07/2007