Provider First Line Business Practice Location Address:
200 S JORDAN AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF SPEECH AND HEARING SCIENCES
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-855-1069
Provider Business Practice Location Address Fax Number:
812-855-5561
Provider Enumeration Date:
10/27/2005