Provider First Line Business Practice Location Address:
969 W MCCLAIN AVE STE B
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:
47170-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-754-1660
Provider Business Practice Location Address Fax Number:
812-754-1664
Provider Enumeration Date:
03/09/2006