Provider First Line Business Practice Location Address:
4TH AND CHESTNUT ST
Provider Second Line Business Practice Location Address:
INDIANA STATE UNIVERSITY
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47809-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-237-9613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006