Provider First Line Business Practice Location Address:
3152 N COUNTY ROAD 125 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47362-9059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-533-4123
Provider Business Practice Location Address Fax Number:
765-287-8842
Provider Enumeration Date:
11/15/2006