Provider First Line Business Practice Location Address:
1410 LOWER HUNTINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46819-1359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-478-7320
Provider Business Practice Location Address Fax Number:
260-478-7408
Provider Enumeration Date:
03/05/2007