Provider First Line Business Practice Location Address:
117 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-724-4145
Provider Business Practice Location Address Fax Number:
812-724-4145
Provider Enumeration Date:
11/07/2006