Provider First Line Business Practice Location Address:
1229 N LIMA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENDALLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-347-1637
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2006