Provider First Line Business Practice Location Address:
3115 N HARLEM AVE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60634-4683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-282-4793
Provider Business Practice Location Address Fax Number:
773-282-4844
Provider Enumeration Date:
07/23/2006