Provider First Line Business Practice Location Address:
3322 N ASHLAND AVE
Provider Second Line Business Practice Location Address:
C/O LAKEVIEW CENTER FOR PSYCHOTHERAPY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-505-7570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2007