Provider First Line Business Practice Location Address:
3930 E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-563-8453
Provider Business Practice Location Address Fax Number:
260-569-0335
Provider Enumeration Date:
12/22/2020