Provider First Line Business Practice Location Address:
19552 S HARLEM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60423-6733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-806-0019
Provider Business Practice Location Address Fax Number:
815-806-0851
Provider Enumeration Date:
02/22/2007