Provider First Line Business Practice Location Address:
1215 HEALTHCARE PL STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46804-7789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-425-2690
Provider Business Practice Location Address Fax Number:
260-425-2691
Provider Enumeration Date:
11/16/2023