Provider First Line Business Practice Location Address:
1900 CAREW ST
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46805-4765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-373-9800
Provider Business Practice Location Address Fax Number:
260-373-9949
Provider Enumeration Date:
06/22/2005