Provider First Line Business Practice Location Address:
1481 WEST 10TH STREET
Provider Second Line Business Practice Location Address:
RICHARD L. ROUDEBUSH VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-988-4699
Provider Business Practice Location Address Fax Number:
317-988-3163
Provider Enumeration Date:
07/16/2008