Provider First Line Business Practice Location Address:
39336 N IL ROUTE 59
Provider Second Line Business Practice Location Address:
DURABLE MEDICAL EQUIPMENT SUPPLIER
Provider Business Practice Location Address City Name:
LAKE VILLA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60046-9603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-838-9253
Provider Business Practice Location Address Fax Number:
847-838-9253
Provider Enumeration Date:
11/20/2006