Provider First Line Business Practice Location Address:
101 W WASHINGTON CENTER RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46825-4357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-482-8503
Provider Business Practice Location Address Fax Number:
260-484-1620
Provider Enumeration Date:
01/29/2007