Provider First Line Business Practice Location Address:
2802 LAFAYETTE ROAD SUITE 13
Provider Second Line Business Practice Location Address:
EAGLEDALE HEALTH CENTER
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46222-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-923-7510
Provider Business Practice Location Address Fax Number:
317-923-7518
Provider Enumeration Date:
09/26/2011