Provider First Line Business Practice Location Address:
1024 S 6TH ST
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-234-7128
Provider Business Practice Location Address Fax Number:
812-231-0104
Provider Enumeration Date:
05/10/2006