Provider First Line Business Practice Location Address:
2227 W SCHOOL ST
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60618-6321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-343-9559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2013