Provider First Line Business Practice Location Address:
1733 N HARLEM AVE
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:
60707-4305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-237-6666
Provider Business Practice Location Address Fax Number:
773-237-7350
Provider Enumeration Date:
09/06/2007