Provider First Line Business Practice Location Address:
INDIANA STATE UNIVERSITY ATHLETIC TRAINING DEPT
Provider Second Line Business Practice Location Address:
ARENA BUILDING C-9
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:
812-237-8336
Provider Business Practice Location Address Fax Number:
812-237-4368
Provider Enumeration Date:
09/10/2005