Provider First Line Business Practice Location Address:
4684 S US HIGHWAY 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:
47802-5404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-4925
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2006