Provider First Line Business Practice Location Address:
1600 N 3RD ST
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:
47804-4045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-235-3715
Provider Business Practice Location Address Fax Number:
812-235-3742
Provider Enumeration Date:
01/30/2007