Provider First Line Business Practice Location Address:
8422 UNION CHAPEL RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-319-1126
Provider Business Practice Location Address Fax Number:
260-627-0772
Provider Enumeration Date:
04/04/2007