Provider First Line Business Practice Location Address:
4833 MELVILLE AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST CHICAGO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46312-3555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-468-8417
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2026