Provider First Line Business Practice Location Address:
1000 S MAIN ST
Provider Second Line Business Practice Location Address:
TIPTON HOSPITAL, SUITE C
Provider Business Practice Location Address City Name:
TIPTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46072-9753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-675-1405
Provider Business Practice Location Address Fax Number:
765-675-8242
Provider Enumeration Date:
11/14/2005