Provider First Line Business Practice Location Address:
3438 SOUTH 7TH 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:
47802-4017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-235-9338
Provider Business Practice Location Address Fax Number:
812-235-9338
Provider Enumeration Date:
11/29/2006