Provider First Line Business Practice Location Address:
607 E 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47841-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-939-2562
Provider Business Practice Location Address Fax Number:
812-939-2786
Provider Enumeration Date:
06/01/2009