Provider First Line Business Practice Location Address:
US HWY 231 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOOGOOTEE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-295-2646
Provider Business Practice Location Address Fax Number:
812-295-9495
Provider Enumeration Date:
12/27/2005