Provider First Line Business Practice Location Address:
2828 NORTH CLARK STREET
Provider Second Line Business Practice Location Address:
SUITE 309 METRO SPINE AND SPORTS REHAB
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-525-0190
Provider Business Practice Location Address Fax Number:
773-525-0583
Provider Enumeration Date:
07/15/2006