| Provider Type: | Other Service Providers |
| Provider Classification: | Specialist |
| Definition of Specialization: | |
| Address: |
1098 S State Road 25 Logansport, IN 46947-6723 |
| Phone: | (574) 737-3850 |
| Fax: | (574) 735-3414 |
| Gender: | Male |
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