Provider First Line Business Practice Location Address:
801 E. LASALLE AVE.
Provider Second Line Business Practice Location Address:
ST. JOSEPH REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-233-3123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006