Provider First Line Business Practice Location Address:
48 E CHICAGO 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:
60611-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-642-1138
Provider Business Practice Location Address Fax Number:
312-642-1349
Provider Enumeration Date:
07/25/2007