Provider First Line Business Practice Location Address:
1921 N HARLEM AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60707-3740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-235-0800
Provider Business Practice Location Address Fax Number:
847-657-1622
Provider Enumeration Date:
11/24/2006