Provider First Line Business Practice Location Address:
5524 W HARRISON ST
Provider Second Line Business Practice Location Address:
OUTPATIENT MENTAL HEALTH
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60644-5032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-854-5290
Provider Business Practice Location Address Fax Number:
773-854-5311
Provider Enumeration Date:
12/14/2010