Provider First Line Business Practice Location Address:
ATTN: GRACE EKONG AT EAST POINT BUILDING
Provider Second Line Business Practice Location Address:
6101 N. SHERIDAN RD, EAST SUITE 9B
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60660-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-973-1236
Provider Business Practice Location Address Fax Number:
773-974-6157
Provider Enumeration Date:
08/18/2016