Provider First Line Business Practice Location Address:
2105 E NATIONAL AVE
Provider Second Line Business Practice Location Address:
LOIS LYNN MOSS MD
Provider Business Practice Location Address City Name:
BRAZIL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47834-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-443-7605
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006