Provider First Line Business Practice Location Address:
550 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
UH1451
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-5149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-274-7398
Provider Business Practice Location Address Fax Number:
317-278-1044
Provider Enumeration Date:
10/21/2005