Provider First Line Business Practice Location Address:
1530 N 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47807-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-242-3115
Provider Business Practice Location Address Fax Number:
812-235-9580
Provider Enumeration Date:
09/22/2009