Provider First Line Business Practice Location Address:
3000 N HALSTED ST
Provider Second Line Business Practice Location Address:
527
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-5188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-328-5930
Provider Business Practice Location Address Fax Number:
773-433-3145
Provider Enumeration Date:
02/27/2007