Provider First Line Business Practice Location Address:
2501 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:
46755-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-343-0149
Provider Business Practice Location Address Fax Number:
260-343-0283
Provider Enumeration Date:
08/30/2006