Provider First Line Business Practice Location Address: 
405 LAKE ZURICH 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: 
60010-3141
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
847-381-5599
    Provider Business Practice Location Address Fax Number: 
847-381-1431
    Provider Enumeration Date: 
03/18/2011