Provider First Line Business Practice Location Address:
3363 S. US HWY 41
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-238-3900
Provider Business Practice Location Address Fax Number:
812-232-3076
Provider Enumeration Date:
08/21/2007