Provider First Line Business Practice Location Address:
729 HIGH ST
Provider Second Line Business Practice Location Address:
LOGANSPORT JUVENILE FACILITY
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-753-5549
Provider Business Practice Location Address Fax Number:
574-722-1274
Provider Enumeration Date:
04/12/2007