Provider First Line Business Practice Location Address:
6307 W COUNTY ROAD 325 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947-6742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-513-7223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2026