Provider First Line Business Practice Location Address:
1010 DIXIE HWY
Provider Second Line Business Practice Location Address:
STATE OF ILLINOIS DEPT. OF HUMAN SERVICES
Provider Business Practice Location Address City Name:
CHICAGO HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-709-3316
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2023