Provider First Line Business Practice Location Address:
3048 N HARLEM AVE
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:
60634-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-237-3544
Provider Business Practice Location Address Fax Number:
773-237-0902
Provider Enumeration Date:
07/07/2006