Provider First Line Business Practice Location Address:
10909 S. WESTERN AVENUE
Provider Second Line Business Practice Location Address:
SPORTS AND ORTHO
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-779-7970
Provider Business Practice Location Address Fax Number:
773-779-7969
Provider Enumeration Date:
02/05/2010