Provider First Line Business Practice Location Address:
1429 NORTH SIXTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-234-3788
Provider Business Practice Location Address Fax Number:
812-235-3330
Provider Enumeration Date:
07/30/2013