Provider First Line Business Practice Location Address:
4321 FIR ST ST CATHERINE HOSPITAL
Provider Second Line Business Practice Location Address:
SUITE313
Provider Business Practice Location Address City Name:
EAST CHICAGO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-392-7424
Provider Business Practice Location Address Fax Number:
219-392-7450
Provider Enumeration Date:
12/21/2006