Provider First Line Business Practice Location Address:
2200 N HALSTED ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-935-4444
Provider Business Practice Location Address Fax Number:
773-935-4455
Provider Enumeration Date:
05/03/2007