Provider First Line Business Practice Location Address:
1706 MEDICAL ARTS DR
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
HUNTINGBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47542-9049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-471-4611
Provider Business Practice Location Address Fax Number:
812-471-4643
Provider Enumeration Date:
11/02/2006