Provider First Line Business Practice Location Address:
19074 DOUGLAS ROAD
Provider Second Line Business Practice Location Address:
HOLY CROSS HOUSE CLINIC
Provider Business Practice Location Address City Name:
NOTRE DAME
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-631-5471
Provider Business Practice Location Address Fax Number:
574-631-1599
Provider Enumeration Date:
03/29/2011