Provider First Line Business Practice Location Address:
1221 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46825-5827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-471-2000
Provider Business Practice Location Address Fax Number:
260-471-2100
Provider Enumeration Date:
03/19/2007