Provider First Line Business Practice Location Address: 
8401 HARCOURT ROAD
    Provider Second Line Business Practice Location Address: 
ST VINCENT STRESS CENTER
    Provider Business Practice Location Address City Name: 
INDIANAPOLIS
    Provider Business Practice Location Address State Name: 
IN
    Provider Business Practice Location Address Postal Code: 
46260
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
317-338-4600
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/22/2014