Provider First Line Business Practice Location Address:
7905 CALUMET AVE
Provider Second Line Business Practice Location Address:
HAMMOND CLINIC LLC
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-5800
Provider Business Practice Location Address Fax Number:
219-836-8073
Provider Enumeration Date:
10/01/2005