Provider First Line Business Practice Location Address:
1600 E SPRINGHILL DR
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:
47802-4363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-994-1404
Provider Business Practice Location Address Fax Number:
812-742-9420
Provider Enumeration Date:
12/29/2006