Provider First Line Business Practice Location Address:
5399 S US HIGHWAY 41
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-4778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-298-8883
Provider Business Practice Location Address Fax Number:
812-298-8889
Provider Enumeration Date:
12/11/2009