Provider First Line Business Practice Location Address:
8733 W. 400 N.
Provider Second Line Business Practice Location Address:
400 NORTH MEDICAL CENTER
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-774-8307
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2011