Provider First Line Business Practice Location Address:
1850 W ROOSEVELT ROAD
Provider Second Line Business Practice Location Address:
THE CHICAGO LIGHTHOUSE
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-666-1331
Provider Business Practice Location Address Fax Number:
312-997-3663
Provider Enumeration Date:
08/21/2006