Provider First Line Business Practice Location Address:
120 W MCCLAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47170-2046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-752-2021
Provider Business Practice Location Address Fax Number:
812-752-7688
Provider Enumeration Date:
07/25/2006