Provider First Line Business Practice Location Address:
101 E 2ND ST
Provider Second Line Business Practice Location Address:
ROOM 105, COURT HOUSE
Provider Business Practice Location Address City Name:
RUSHVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46173-1871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-932-3103
Provider Business Practice Location Address Fax Number:
765-938-2604
Provider Enumeration Date:
09/14/2009