Provider First Line Business Practice Location Address:
4242 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:
60639-3647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-227-8874
Provider Business Practice Location Address Fax Number:
773-227-8284
Provider Enumeration Date:
01/17/2007