Provider First Line Business Practice Location Address:
412 W PAULDING RD
Provider Second Line Business Practice Location Address:
412 WEST PAULDING ROAD
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46807-3430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-745-3619
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2010