Provider First Line Business Practice Location Address:
1201 MICHIGAN AVE STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-722-3338
Provider Business Practice Location Address Fax Number:
574-753-1551
Provider Enumeration Date:
10/31/2006