JACK GARDEN

SOUTH BEND, IN
NPI1194860304
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy103TH0100X Psychologist, Health Service
(Licence: IN  20041199A)
Enumeration Date2007-02-21
Last Update Date2007-07-08
Business Address
-- JACK GARDEN HSPP
403 E MADISON ST
SOUTH BEND, IN 46617-2322
Phone number: 574-283-1107
Mailing Address
-- JACK GARDEN HSPP
403 E MADISON ST
SOUTH BEND, IN 46617-2322
Phone number: 574-283-1107
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