Provider First Line Business Practice Location Address:
21 JOLIET ST
Provider Second Line Business Practice Location Address:
BEHAVIORLAL HEALTH OP
Provider Business Practice Location Address City Name:
DYER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-865-2141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2007