Provider First Line Business Practice Location Address:
730 N PULASKI RD
Provider Second Line Business Practice Location Address:
ROOM 109 ORR SCHOOL BASE HEALTH CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60624-1063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-534-8924
Provider Business Practice Location Address Fax Number:
773-534-8927
Provider Enumeration Date:
02/27/2007