Provider First Line Business Practice Location Address:
8849 W STATE ROAD 56
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:
47432-9395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-936-5222
Provider Business Practice Location Address Fax Number:
812-936-5225
Provider Enumeration Date:
09/09/2011