Provider First Line Business Practice Location Address:
4251 LAHMEYER 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:
46815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-482-7800
Provider Business Practice Location Address Fax Number:
260-484-0273
Provider Enumeration Date:
12/22/2011