Provider First Line Business Practice Location Address:
1516 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47362-4355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-836-5047
Provider Business Practice Location Address Fax Number:
765-591-8171
Provider Enumeration Date:
06/20/2007