Provider First Line Business Practice Location Address:
99 E DEWEY ST
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:
46947-4933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-737-8634
Provider Business Practice Location Address Fax Number:
574-217-4825
Provider Enumeration Date:
04/01/2016