Provider First Line Business Practice Location Address:
200 S JORDAN AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF SPEECH AND HEARING SCIENCES
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47405-7002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-856-4727
Provider Business Practice Location Address Fax Number:
812-855-5561
Provider Enumeration Date:
10/12/2005