Provider First Line Business Practice Location Address:
6020 S HALSTED ST
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:
60621-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-488-9608
Provider Business Practice Location Address Fax Number:
773-488-9605
Provider Enumeration Date:
09/28/2006