Provider First Line Business Practice Location Address:
401 N 4TH ST
Provider Second Line Business Practice Location Address:
HHP BLDG RM B-17
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47809-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-237-4062
Provider Business Practice Location Address Fax Number:
812-237-9612
Provider Enumeration Date:
08/26/2006