Provider First Line Business Practice Location Address:
217 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47501-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-254-5141
Provider Business Practice Location Address Fax Number:
812-254-5143
Provider Enumeration Date:
12/27/2005