Provider First Line Business Practice Location Address:
1000 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MICHIGAN CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46360-4266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-874-1400
Provider Business Practice Location Address Fax Number:
219-874-1398
Provider Enumeration Date:
08/31/2006