Provider First Line Business Practice Location Address:
2855 NORTHPARK AVE
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46750-9736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-356-6422
Provider Business Practice Location Address Fax Number:
260-356-6423
Provider Enumeration Date:
02/20/2008