Provider First Line Business Practice Location Address:
1143 1ST 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:
46750-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-356-6666
Provider Business Practice Location Address Fax Number:
260-356-6449
Provider Enumeration Date:
10/18/2007