Provider First Line Business Practice Location Address:
3110 W ARMITAGE 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:
60647-3819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-235-6758
Provider Business Practice Location Address Fax Number:
773-235-1348
Provider Enumeration Date:
07/29/2006