Provider First Line Business Practice Location Address:
THE SPRINGS AT LAFAYETTE
Provider Second Line Business Practice Location Address:
2402 SOUTH STREET
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-340-8125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2022