Provider First Line Business Practice Location Address:
114 W HONEY CREEK PKWY
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:
47802-4114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-234-6500
Provider Business Practice Location Address Fax Number:
812-232-8921
Provider Enumeration Date:
09/20/2007