Provider First Line Business Practice Location Address:
1543 S 7TH ST
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:
47802-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-235-9980
Provider Business Practice Location Address Fax Number:
812-234-7334
Provider Enumeration Date:
02/07/2007