Provider First Line Business Practice Location Address:
8212 KENNEDY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46322-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-923-2050
Provider Business Practice Location Address Fax Number:
219-923-2050
Provider Enumeration Date:
11/06/2006