Provider First Line Business Practice Location Address:
1025 MICHIGAN AVENUE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947-1594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-753-2222
Provider Business Practice Location Address Fax Number:
574-753-0522
Provider Enumeration Date:
04/20/2006