Provider First Line Business Practice Location Address:
6TH AND CHESTNUT
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:
47809-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-472-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006