Provider First Line Business Practice Location Address:
230 E 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46051-9579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-742-9730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2026