Provider First Line Business Practice Location Address:
1325 N. 200 E.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-753-9855
Provider Business Practice Location Address Fax Number:
574-753-9855
Provider Enumeration Date:
06/15/2007