Provider First Line Business Practice Location Address:
2732 WEST MICHIGAN ST.
Provider Second Line Business Practice Location Address:
WESTSIDE HEALTH CENTER
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-554-4607
Provider Business Practice Location Address Fax Number:
317-554-4617
Provider Enumeration Date:
02/08/2011