Provider First Line Business Practice Location Address:
1250 E COUNTY LINE RD
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46227-0989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-859-2905
Provider Business Practice Location Address Fax Number:
317-859-2909
Provider Enumeration Date:
07/15/2006