Provider First Line Business Practice Location Address:
2150 N. TIFFIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-533-0045
Provider Business Practice Location Address Fax Number:
812-533-9935
Provider Enumeration Date:
11/08/2006