Provider First Line Business Practice Location Address:
757 E LEWIS AND CLARK PKWY
Provider Second Line Business Practice Location Address:
GREEN TREE MALL DENTAL BLDG
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47129-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-288-6681
Provider Business Practice Location Address Fax Number:
812-288-6733
Provider Enumeration Date:
08/03/2006