Provider First Line Business Practice Location Address:
1213 E COOLSPRING AVENUE
Provider Second Line Business Practice Location Address:
COOLSPRING DENTAL CLINIC
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:
219-872-9151
Provider Business Practice Location Address Fax Number:
219-873-3341
Provider Enumeration Date:
10/24/2006