Provider First Line Business Practice Location Address:
1521 S 3RD ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-917-5249
Provider Business Practice Location Address Fax Number:
812-917-5042
Provider Enumeration Date:
06/09/2010