Provider First Line Business Practice Location Address:
2370 N NEWCASTLE 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:
60707-2955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-385-5002
Provider Business Practice Location Address Fax Number:
773-385-9858
Provider Enumeration Date:
12/17/2008