Provider First Line Business Practice Location Address:
500 E SPRINGHILL DR
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-4439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-2145
Provider Business Practice Location Address Fax Number:
812-232-1416
Provider Enumeration Date:
07/02/2006