Provider First Line Business Practice Location Address:
5517 SOUTH MICHIGAN STREET
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-643-0227
Provider Business Practice Location Address Fax Number:
773-643-0227
Provider Enumeration Date:
11/01/2006