Provider First Line Business Practice Location Address:
8145 KENNEDY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46322-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-803-6630
Provider Business Practice Location Address Fax Number:
219-937-7237
Provider Enumeration Date:
08/24/2026