Provider First Line Business Practice Location Address:
2201 S HALSTED ST
Provider Second Line Business Practice Location Address:
STE. 1252
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-4585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-226-9989
Provider Business Practice Location Address Fax Number:
312-997-9985
Provider Enumeration Date:
03/06/2008