Provider First Line Business Practice Location Address:
512 N LINE STREET
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:
46725-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-244-6474
Provider Business Practice Location Address Fax Number:
260-244-6815
Provider Enumeration Date:
12/30/2006