Provider First Line Business Practice Location Address:
2301 CUMBERLAND DR
Provider Second Line Business Practice Location Address:
RECOVERY CENTER
Provider Business Practice Location Address City Name:
VALPARAISO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46383-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-476-4676
Provider Business Practice Location Address Fax Number:
219-462-2381
Provider Enumeration Date:
03/02/2012