Provider First Line Business Practice Location Address:
314 W SUPERIOR ST
Provider Second Line Business Practice Location Address:
LL-E, LATERAL FITNESS
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60654-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-220-1062
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2017