Provider First Line Business Practice Location Address:
9820 N MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
UNIT C & D
Provider Business Practice Location Address City Name:
DES PLAINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60016-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-458-6597
Provider Business Practice Location Address Fax Number:
815-458-7934
Provider Enumeration Date:
11/13/2006