Provider First Line Business Practice Location Address:
1182 N MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
STOREFRONT
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60642-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-394-6990
Provider Business Practice Location Address Fax Number:
773-394-6993
Provider Enumeration Date:
10/11/2008