Provider First Line Business Practice Location Address:
1001 MCKINLEY AVE.
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ATHLETICS
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-257-2677
Provider Business Practice Location Address Fax Number:
574-257-3385
Provider Enumeration Date:
10/18/2005