Provider First Line Business Practice Location Address:
2400 SOUTH ST
Provider Second Line Business Practice Location Address:
GREATER LAFAYETTE HEALTH SERVICES FOOD AND NUTRITION
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47904-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-449-5139
Provider Business Practice Location Address Fax Number:
765-449-3061
Provider Enumeration Date:
11/17/2006