Provider First Line Business Practice Location Address:
100 WELLNESS CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46556-4655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-271-5622
Provider Business Practice Location Address Fax Number:
574-271-9304
Provider Enumeration Date:
01/27/2007