Provider First Line Business Practice Location Address:
441 W NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENDALLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46755-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-854-4942
Provider Business Practice Location Address Fax Number:
260-349-1320
Provider Enumeration Date:
09/25/2006