Provider First Line Business Practice Location Address:
1518 WASHINGTON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47362-4355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-521-0336
Provider Business Practice Location Address Fax Number:
765-521-0337
Provider Enumeration Date:
11/14/2006