Provider First Line Business Practice Location Address:
3115 N HARLEM AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60634-4684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-777-4444
Provider Business Practice Location Address Fax Number:
312-736-7873
Provider Enumeration Date:
06/02/2006