Provider First Line Business Practice Location Address:
2837 S HALSTED ST
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:
60608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-326-1189
Provider Business Practice Location Address Fax Number:
312-326-0163
Provider Enumeration Date:
06/12/2008