Provider First Line Business Practice Location Address:
2323 N SHEFFIELD AVE
Provider Second Line Business Practice Location Address:
DEPAUL UNIVERSITY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-3290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-325-4894
Provider Business Practice Location Address Fax Number:
773-325-7531
Provider Enumeration Date:
03/15/2006