Provider First Line Business Practice Location Address:
1925 N HARLEM AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60707-3743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-237-2655
Provider Business Practice Location Address Fax Number:
773-237-2717
Provider Enumeration Date:
01/09/2007