Provider First Line Business Practice Location Address:
600 N JORDAN AVE
Provider Second Line Business Practice Location Address:
COUNSELING AND PSYCHOLOGICAL SERVICES
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47405-3190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-855-9782
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2009