Provider First Line Business Practice Location Address:
4235 W ARMITAGE AVE
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:
60639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-342-1600
Provider Business Practice Location Address Fax Number:
773-342-1601
Provider Enumeration Date:
09/14/2006