Provider First Line Business Practice Location Address:
1504 N JEFFERSON 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:
46750-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-356-1212
Provider Business Practice Location Address Fax Number:
260-358-4603
Provider Enumeration Date:
02/19/2010