Provider First Line Business Practice Location Address:
METHODIST HOSPITAL ROOM B401
Provider Second Line Business Practice Location Address:
I-65 AT 21ST STREET
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-962-5500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2007