Provider First Line Business Practice Location Address:
351 NORTH ALLEN CHAPEL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENDALLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46755-0429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-447-0800
Provider Business Practice Location Address Fax Number:
260-349-0376
Provider Enumeration Date:
06/09/2006