Provider First Line Business Practice Location Address:
820 FULTON 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-722-3636
Provider Business Practice Location Address Fax Number:
574-732-0754
Provider Enumeration Date:
02/02/2006