Provider First Line Business Practice Location Address:
3220 W ARMITAGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60647-3797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-904-8747
Provider Business Practice Location Address Fax Number:
773-904-7234
Provider Enumeration Date:
06/27/2012