Provider First Line Business Practice Location Address:
1501 WABASH ST
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
MICHIGAN CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46360-4357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-872-7555
Provider Business Practice Location Address Fax Number:
219-872-8671
Provider Enumeration Date:
10/03/2006