Provider First Line Business Practice Location Address:
VA MEDICAL CENTER (119)
Provider Second Line Business Practice Location Address:
1481 W 10TH STREET
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-613-2315
Provider Business Practice Location Address Fax Number:
317-613-2316
Provider Enumeration Date:
09/29/2006