Provider First Line Business Practice Location Address:
1103 EAST GRACE STREET
Provider Second Line Business Practice Location Address:
CLINIC OF FAMILY MEDICINE
Provider Business Practice Location Address City Name:
RENSSELAER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47978-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-866-4135
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006