Provider First Line Business Practice Location Address:
1743 N HARLEM AVE
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:
60707-4305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-529-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2006