Provider First Line Business Practice Location Address:
22 VINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46750-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-356-9550
Provider Business Practice Location Address Fax Number:
260-356-5181
Provider Enumeration Date:
05/08/2006