Provider First Line Business Practice Location Address:
210 S MERIDIAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-254-7474
Provider Business Practice Location Address Fax Number:
812-254-7772
Provider Enumeration Date:
01/18/2007