Provider First Line Business Practice Location Address:
1643 N COUNTY ROAD 50 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:
46947-8711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-497-3738
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2023