Provider First Line Business Practice Location Address:
139 S EAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROTHERSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47229-9635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-793-2570
Provider Business Practice Location Address Fax Number:
812-793-2570
Provider Enumeration Date:
11/15/2005