Provider First Line Business Practice Location Address:
15 N FRANKLIN ST.
Provider Second Line Business Practice Location Address:
CLINICAL PSYCHOLOGY CENTER PC
Provider Business Practice Location Address City Name:
VALPARAISO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-462-4770
Provider Business Practice Location Address Fax Number:
219-464-8156
Provider Enumeration Date:
06/21/2005