Provider First Line Business Practice Location Address:
2300 CHILDRENS PLAZA BOX#
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:
60614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-880-4553
Provider Business Practice Location Address Fax Number:
773-880-8111
Provider Enumeration Date:
03/24/2006