Provider First Line Business Practice Location Address:
PM&R (117)
Provider Second Line Business Practice Location Address:
820 SOUTH DAMEN AVE
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-569-7834
Provider Business Practice Location Address Fax Number:
312-569-8050
Provider Enumeration Date:
06/08/2006