Provider First Line Business Practice Location Address:
3210 WATLING ST
Provider Second Line Business Practice Location Address:
MEDICAL DEPT. 8-210
Provider Business Practice Location Address City Name:
EAST CHICAGO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46312-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-399-3133
Provider Business Practice Location Address Fax Number:
219-399-5814
Provider Enumeration Date:
12/15/2009