Provider First Line Business Practice Location Address:
19558 S. HARLEM AVE.
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60423-6743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-469-1900
Provider Business Practice Location Address Fax Number:
815-469-1906
Provider Enumeration Date:
10/09/2008