Provider First Line Business Practice Location Address:
2331 LAFAYETTE AVE
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:
47805-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-466-1726
Provider Business Practice Location Address Fax Number:
812-466-1726
Provider Enumeration Date:
01/09/2006