Provider First Line Business Practice Location Address:
4039 W ARMITAGE AVE
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:
60639-3764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-252-6852
Provider Business Practice Location Address Fax Number:
443-252-6852
Provider Enumeration Date:
04/03/2007