Provider First Line Business Practice Location Address:
327 E WAYNE ST STE 150
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:
46802-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-420-2800
Provider Business Practice Location Address Fax Number:
888-251-0972
Provider Enumeration Date:
02/18/2008