Provider First Line Business Practice Location Address:
5425 W ADDISON ST
Provider Second Line Business Practice Location Address:
OLD IRVING PARK COMMUNITY CLINIC
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60641-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-427-0298
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2012