Provider First Line Business Practice Location Address:
467 W DEMING
Provider Second Line Business Practice Location Address:
CHILDRENS PRIMARY CARE SUITE 600
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-327-9125
Provider Business Practice Location Address Fax Number:
773-327-0419
Provider Enumeration Date:
03/24/2006