Provider First Line Business Practice Location Address:
INDIANA STATE UNIVERSITY
Provider Second Line Business Practice Location Address:
ATHLETIC TRAINING DEPARTMENT
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:
812-237-4062
Provider Business Practice Location Address Fax Number:
812-237-9612
Provider Enumeration Date:
08/20/2007