Provider First Line Business Practice Location Address:
301 S WABENA AVE
Provider Second Line Business Practice Location Address:
MINOOKA COMMUNITY HIGH SCHOOL
Provider Business Practice Location Address City Name:
MINOOKA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60447-9466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-467-2140
Provider Business Practice Location Address Fax Number:
815-467-7762
Provider Enumeration Date:
03/16/2006