Provider First Line Business Practice Location Address:
920 W NORTH ST
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:
46755-0755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-347-4020
Provider Business Practice Location Address Fax Number:
260-347-4405
Provider Enumeration Date:
07/26/2006