Provider First Line Business Practice Location Address:
6925 S HARDING ST
Provider Second Line Business Practice Location Address:
SUITE B-1
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-497-6140
Provider Business Practice Location Address Fax Number:
317-497-6147
Provider Enumeration Date:
01/30/2007