Provider First Line Business Practice Location Address:
12198 N COUNTY ROAD 600 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMAR
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47550-7267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-529-8378
Provider Business Practice Location Address Fax Number:
812-529-8360
Provider Enumeration Date:
06/07/2007