Provider First Line Business Practice Location Address:
1818 N 3RD ST
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:
47804-4041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-478-9494
Provider Business Practice Location Address Fax Number:
812-478-9393
Provider Enumeration Date:
06/30/2005