Provider First Line Business Practice Location Address:
2222 LAFAYETTE AVE
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:
47805-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-466-2400
Provider Business Practice Location Address Fax Number:
812-466-5200
Provider Enumeration Date:
11/02/2011