Provider First Line Business Practice Location Address:
1530 S MILLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46176-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-392-6166
Provider Business Practice Location Address Fax Number:
317-392-6196
Provider Enumeration Date:
09/26/2006