Provider First Line Business Practice Location Address:
122 SOUTH MICHIGAN AVENUE
Provider Second Line Business Practice Location Address:
MICHIGAN AVENUE DENTAL ASSOCIATES SUITE 1212
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60603-6191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-922-9595
Provider Business Practice Location Address Fax Number:
312-922-9599
Provider Enumeration Date:
03/24/2006