Provider First Line Business Practice Location Address:
1 SISTERS OF PROVIDENCE
Provider Second Line Business Practice Location Address:
PROVIDENCE HEALTH CARE CENTER
Provider Business Practice Location Address City Name:
ST. MARY WOODS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47876-1095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-535-1051
Provider Business Practice Location Address Fax Number:
812-535-1005
Provider Enumeration Date:
03/21/2006