Provider First Line Business Practice Location Address:
200 MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
OTRAGEN ORTHODONTICS PC
Provider Business Practice Location Address City Name:
BUFFALO GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60089-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-520-0770
Provider Business Practice Location Address Fax Number:
847-520-1179
Provider Enumeration Date:
12/06/2010