Provider First Line Business Practice Location Address:
3666 W IRVING PARK RD
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:
60618-4132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-478-1500
Provider Business Practice Location Address Fax Number:
773-478-1926
Provider Enumeration Date:
11/21/2006