Provider First Line Business Practice Location Address:
GENNESARET CLINIC
Provider Second Line Business Practice Location Address:
3001 EAST 30TH ST.
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-696-1511
Provider Business Practice Location Address Fax Number:
317-639-5609
Provider Enumeration Date:
05/22/2006