Provider First Line Business Practice Location Address:
413 E JEFFERSON BLVD
Provider Second Line Business Practice Location Address:
MATTHEW 25 HEALTH AND DENTAL CLINIC
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46802-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-426-3250
Provider Business Practice Location Address Fax Number:
260-426-0443
Provider Enumeration Date:
05/23/2005