Provider First Line Business Practice Location Address: 
5214 SOUTH EAST STREET
    Provider Second Line Business Practice Location Address: 
BLDG D SUITE 1 HTS OUTHPATIENT THERAPY SERVICES
    Provider Business Practice Location Address City Name: 
INDIANAPOLIS
    Provider Business Practice Location Address State Name: 
IN
    Provider Business Practice Location Address Postal Code: 
46227
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
800-486-4449
    Provider Business Practice Location Address Fax Number: 
317-780-3750
    Provider Enumeration Date: 
12/29/2007