Provider First Line Business Practice Location Address:
2400 SOUTH STREET
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PATHOLOGY
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-446-7201
Provider Business Practice Location Address Fax Number:
765-448-2921
Provider Enumeration Date:
02/02/2007