Provider First Line Business Practice Location Address:
C/O EAST PRAIRIE SCHOOL
Provider Second Line Business Practice Location Address:
7616 N. EAST PRAIRIE ROAD
Provider Business Practice Location Address City Name:
SKOKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-673-1141
Provider Business Practice Location Address Fax Number:
847-673-1186
Provider Enumeration Date:
09/04/2019