Provider First Line Business Practice Location Address:
777 E ALGONQUIN RD
Provider Second Line Business Practice Location Address:
COMMUNITY CONSOLIDATED SCHOOL DIST 62
Provider Business Practice Location Address City Name:
DES PLAINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60016-6251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-824-1136
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007