Provider First Line Business Practice Location Address:
2641 W HARRISON ST
Provider Second Line Business Practice Location Address:
COAST PT & AQUATIC REHAB @ QUEST
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-3420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-215-3784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2015