Provider First Line Business Practice Location Address:
111S1 S NEW ENGLAND
Provider Second Line Business Practice Location Address:
WORTH JUNIOR HIGH
Provider Business Practice Location Address City Name:
WORTH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-448-2803
Provider Business Practice Location Address Fax Number:
708-448-6155
Provider Enumeration Date:
06/14/2006