Provider First Line Business Practice Location Address: 
9600 GROSS POINT RD
    Provider Second Line Business Practice Location Address: 
PATIENT CARE SERVICES
    Provider Business Practice Location Address City Name: 
SKOKIE
    Provider Business Practice Location Address State Name: 
IL
    Provider Business Practice Location Address Postal Code: 
60076-1214
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
847-933-6091
    Provider Business Practice Location Address Fax Number: 
847-933-6058
    Provider Enumeration Date: 
07/29/2008