Provider First Line Business Practice Location Address:
1655 W SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-1043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-519-3187
Provider Business Practice Location Address Fax Number:
773-325-7781
Provider Enumeration Date:
07/03/2007