Provider First Line Business Practice Location Address:
567 N 5TH ST
Provider Second Line Business Practice Location Address:
STUDENT SERVICES BUILDING, 246
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47809-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-577-1314
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2010