Provider First Line Business Practice Location Address:
1310 E 7TH ST
Provider Second Line Business Practice Location Address:
DEKALB MEDICAL ARTS BLDG
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46706-2534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-436-6667
Provider Business Practice Location Address Fax Number:
260-469-7437
Provider Enumeration Date:
02/04/2008