Provider First Line Business Practice Location Address:
603 EAST NATIONAL HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47501-4118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-254-5117
Provider Business Practice Location Address Fax Number:
812-254-5066
Provider Enumeration Date:
11/06/2006