Provider First Line Business Practice Location Address:
56 E MCCLAIN AVE
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:
47170-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-381-9673
Provider Business Practice Location Address Fax Number:
812-752-9894
Provider Enumeration Date:
12/22/2011