Provider First Line Business Practice Location Address:
1116 N. KEDZIE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-772-8004
Provider Business Practice Location Address Fax Number:
773-772-1752
Provider Enumeration Date:
05/05/2006