Provider First Line Business Practice Location Address:
68370 CLINTON STREET
Provider Second Line Business Practice Location Address:
POST OFFICE BOX 48
Provider Business Practice Location Address City Name:
NEW PARIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-831-5440
Provider Business Practice Location Address Fax Number:
574-831-6922
Provider Enumeration Date:
01/26/2006