Provider First Line Business Practice Location Address:
2350 N COUNTY ROAD 275 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:
46947-8070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-721-8235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2026