Provider First Line Business Practice Location Address:
4212 E MICHIGAN BLVD
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:
46360-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-874-4449
Provider Business Practice Location Address Fax Number:
219-879-8153
Provider Enumeration Date:
12/05/2006