Provider First Line Business Practice Location Address:
4214 N HARLEM AVE
Provider Second Line Business Practice Location Address:
HARLEM-IRVING PLAZA SHOPPING CENTER
Provider Business Practice Location Address City Name:
NORRIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60706-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-453-6644
Provider Business Practice Location Address Fax Number:
708-452-9532
Provider Enumeration Date:
09/12/2007