Provider First Line Business Practice Location Address:
4126 S 7TH 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:
47802-4123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-645-2308
Provider Business Practice Location Address Fax Number:
317-520-8200
Provider Enumeration Date:
01/27/2009