Provider First Line Business Practice Location Address: 
704 S NORTHWEST HWY
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BARRINGTON
    Provider Business Practice Location Address State Name: 
IL
    Provider Business Practice Location Address Postal Code: 
60010-4620
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
224-512-7200
    Provider Business Practice Location Address Fax Number: 
224-512-7201
    Provider Enumeration Date: 
08/01/2011