Provider First Line Business Practice Location Address:
2303 COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46750-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-359-4287
Provider Business Practice Location Address Fax Number:
260-359-4108
Provider Enumeration Date:
09/16/2005