Provider First Line Business Practice Location Address:
2723 S 7TH ST
Provider Second Line Business Practice Location Address:
SUITE N
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-3584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-2086
Provider Business Practice Location Address Fax Number:
812-234-9103
Provider Enumeration Date:
07/10/2006