Provider First Line Business Practice Location Address: 
800 FOX GLN
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BARRINGTON
    Provider Business Practice Location Address State Name: 
IL
    Provider Business Practice Location Address Postal Code: 
60010-1860
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
847-382-5850
    Provider Business Practice Location Address Fax Number: 
847-382-5852
    Provider Enumeration Date: 
10/18/2007