Provider First Line Business Practice Location Address: 
18-3 E DUNDEE RD
    Provider Second Line Business Practice Location Address: 
SUITE 206
    Provider Business Practice Location Address City Name: 
BARRINGTON
    Provider Business Practice Location Address State Name: 
IL
    Provider Business Practice Location Address Postal Code: 
60010-5292
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
847-277-0047
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
12/01/2006