Provider First Line Business Practice Location Address:
221 N ROGERS ST
Provider Second Line Business Practice Location Address:
CENTERSTONE RECOVERY HOUSE
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47404-3968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-337-2424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2008