Provider First Line Business Practice Location Address:
401 W 10TH ST DEPT OF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-274-7130
Provider Business Practice Location Address Fax Number:
317-274-0133
Provider Enumeration Date:
05/04/2006