Provider First Line Business Practice Location Address:
1818 N RILEY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46176-0070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-392-3231
Provider Business Practice Location Address Fax Number:
317-392-3233
Provider Enumeration Date:
10/10/2006