Provider First Line Business Practice Location Address:
6743 N. SAUGANASH AVE. BASEMENT
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:
60646-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-262-7071
Provider Business Practice Location Address Fax Number:
773-262-7382
Provider Enumeration Date:
06/09/2010