Provider First Line Business Practice Location Address:
1122 N LEBANON ST
Provider Second Line Business Practice Location Address:
KATHLEEN MOSSMAN, LCSW:C/O MENTAL HEALTH AMERICA-BOONE
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46052-1759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-894-2620
Provider Business Practice Location Address Fax Number:
765-482-0288
Provider Enumeration Date:
08/19/2006