Provider First Line Business Practice Location Address:
2163HWY 54 EAST SUBURBAN PLAZA
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LINTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-847-8601
Provider Business Practice Location Address Fax Number:
812-847-8750
Provider Enumeration Date:
03/12/2007