Provider First Line Business Practice Location Address:
1152 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46750-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-356-0500
Provider Business Practice Location Address Fax Number:
260-356-3141
Provider Enumeration Date:
01/31/2007