Provider First Line Business Practice Location Address:
12221 S HARLEM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALOS HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60463-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-923-0075
Provider Business Practice Location Address Fax Number:
708-923-6045
Provider Enumeration Date:
11/25/2006