Provider First Line Business Practice Location Address:
513 N LINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46725-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-244-7542
Provider Business Practice Location Address Fax Number:
260-244-4638
Provider Enumeration Date:
04/14/2008