Provider First Line Business Practice Location Address:
2126 N SEDGWICK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-4620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-665-4246
Provider Business Practice Location Address Fax Number:
773-665-4246
Provider Enumeration Date:
04/24/2006