Provider First Line Business Practice Location Address:
2119 E. NATIONAL HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-254-3301
Provider Business Practice Location Address Fax Number:
812-257-0039
Provider Enumeration Date:
07/11/2007