Provider First Line Business Practice Location Address:
1201 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47557-0006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-743-5113
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2007