Provider First Line Business Practice Location Address:
110 W HONEY CREEK PKWY
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:
47802-4114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-2890
Provider Business Practice Location Address Fax Number:
812-232-3506
Provider Enumeration Date:
06/15/2010