Provider First Line Business Practice Location Address:
4201 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
IWU HEALTH CENTER, STUDENT CENTER #210
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46953-4974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-677-2206
Provider Business Practice Location Address Fax Number:
765-677-2849
Provider Enumeration Date:
10/04/2005