Provider First Line Business Practice Location Address:
1481 W. 10TH STREET, MED SERVICE 111
Provider Second Line Business Practice Location Address:
ROUDEBUSH VA MEDIAL CENTER
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-988-4101
Provider Business Practice Location Address Fax Number:
317-988-3243
Provider Enumeration Date:
06/16/2005