Provider First Line Business Practice Location Address:
1201 S MAIN ST
Provider Second Line Business Practice Location Address:
DEPT: ED
Provider Business Practice Location Address City Name:
CROWN POINT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46307-8481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-757-6310
Provider Business Practice Location Address Fax Number:
219-757-6312
Provider Enumeration Date:
04/26/2006