Provider First Line Business Practice Location Address:
3701 FRANKLIN ST
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:
46360-7310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-872-8844
Provider Business Practice Location Address Fax Number:
219-874-2872
Provider Enumeration Date:
09/15/2006