Provider First Line Business Practice Location Address:
2020 E WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 650
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46803-1327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-422-9800
Provider Business Practice Location Address Fax Number:
260-422-9882
Provider Enumeration Date:
03/21/2006