Provider First Line Business Practice Location Address:
129 E LAKE ST
Provider Second Line Business Practice Location Address:
GENESIS REHAB SERVICES
Provider Business Practice Location Address City Name:
BLOOMINGDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60108-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-278-1942
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2012