Provider First Line Business Practice Location Address:
1801 W TAYLOR ST # 2E
Provider Second Line Business Practice Location Address:
CHILDREN AND ADOLESCENT CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-4319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-7202
Provider Business Practice Location Address Fax Number:
312-413-3445
Provider Enumeration Date:
09/03/2008