Provider First Line Business Practice Location Address:
1104 EAST GRACE STREET
Provider Second Line Business Practice Location Address:
JASPER COUNTY HOSPITAL
Provider Business Practice Location Address City Name:
RENSSELAER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47978-3211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-866-5141
Provider Business Practice Location Address Fax Number:
219-866-3234
Provider Enumeration Date:
05/23/2006