Provider First Line Business Practice Location Address:
2524 N LINCOLN AVE
Provider Second Line Business Practice Location Address:
LINCOLN PARK PSYCHOLOGICAL ASSOCIATE - SUITE J
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-2473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-477-0584
Provider Business Practice Location Address Fax Number:
773-477-0584
Provider Enumeration Date:
03/29/2007