Provider First Line Business Practice Location Address:
50 S MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
SUITE 201 COMMUNITY REHABILITATION
Provider Business Practice Location Address City Name:
LAKE VILLA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-265-3491
Provider Business Practice Location Address Fax Number:
847-265-3498
Provider Enumeration Date:
10/27/2006