Provider First Line Business Practice Location Address:
3851 W OGDEN AVE
Provider Second Line Business Practice Location Address:
ATTN: DENTAL DEPT
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60623-2459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
872-588-3223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2012