Provider First Line Business Practice Location Address:
1634 E STATE RD 44
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46614-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-398-0176
Provider Business Practice Location Address Fax Number:
317-924-3741
Provider Enumeration Date:
10/20/2005