Provider First Line Business Practice Location Address:
269 N HIGHLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46160-9724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-597-1120
Provider Business Practice Location Address Fax Number:
812-597-0452
Provider Enumeration Date:
10/26/2005