Provider First Line Business Practice Location Address:
506 N LINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46725-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-248-4242
Provider Business Practice Location Address Fax Number:
260-248-4222
Provider Enumeration Date:
07/12/2006