Provider First Line Business Practice Location Address:
2433 N HARLEM AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60707-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-889-6355
Provider Business Practice Location Address Fax Number:
773-355-2815
Provider Enumeration Date:
11/16/2009