Provider First Line Business Practice Location Address:
124 E NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENDALLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46755-1124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-349-1530
Provider Business Practice Location Address Fax Number:
260-349-1936
Provider Enumeration Date:
09/15/2011