Provider First Line Business Practice Location Address:
457 S STATE ROAD 145
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCH LICK
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47432-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-936-9991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2007