Provider First Line Business Practice Location Address:
7 MEADOWS SHOPPING CTR # L
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:
47803-2373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-234-3838
Provider Business Practice Location Address Fax Number:
812-234-5026
Provider Enumeration Date:
11/03/2006