Provider First Line Business Practice Location Address:
911 W SCHOOL ST
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:
60657-2576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-353-2954
Provider Business Practice Location Address Fax Number:
773-880-5446
Provider Enumeration Date:
01/03/2007