Provider First Line Business Practice Location Address:
3013 S US HWY 41
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:
47802-3791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-234-4434
Provider Business Practice Location Address Fax Number:
317-924-3741
Provider Enumeration Date:
10/20/2005