Provider First Line Business Practice Location Address:
455 E HOSPITAL LN
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:
47802-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-238-1521
Provider Business Practice Location Address Fax Number:
812-232-6335
Provider Enumeration Date:
02/08/2006