Provider First Line Business Practice Location Address:
1481 WEST 10TH STREET
Provider Second Line Business Practice Location Address:
RLR VA MEDICAL CENTER (119)
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-2884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-988-3295
Provider Business Practice Location Address Fax Number:
317-988-3334
Provider Enumeration Date:
08/24/2006