Provider First Line Business Practice Location Address:
226 US HIGHWAY 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46540-9713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-825-8068
Provider Business Practice Location Address Fax Number:
574-825-4873
Provider Enumeration Date:
02/27/2006