Provider First Line Business Practice Location Address:
117 WABASH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MICHIGAN CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-362-2145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2008