Provider First Line Business Practice Location Address:
49 N HYLAND ST
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:
47170-1259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-752-8922
Provider Business Practice Location Address Fax Number:
812-752-9620
Provider Enumeration Date:
08/16/2011