Provider First Line Business Practice Location Address:
SCHNECK PROFESSIONAL BUILDING
Provider Second Line Business Practice Location Address:
411 WEST TIPTON STREET
Provider Business Practice Location Address City Name:
SEYMOUR
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-519-2388
Provider Business Practice Location Address Fax Number:
812-519-3182
Provider Enumeration Date:
10/17/2006