Provider First Line Business Practice Location Address:
2399 S STATE ROAD 46
Provider Second Line Business Practice Location Address:
WAL-MART VISION CENTER
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47803-9306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-872-2537
Provider Business Practice Location Address Fax Number:
812-872-2539
Provider Enumeration Date:
06/26/2009