Provider First Line Business Practice Location Address:
3684 HIGHWAY 150
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
FLOYDS KNOBS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47119-9692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-923-9837
Provider Business Practice Location Address Fax Number:
812-923-1872
Provider Enumeration Date:
07/08/2005