Provider First Line Business Practice Location Address:
2133 S STATE ROAD 46
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:
47803-9781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-244-1800
Provider Business Practice Location Address Fax Number:
812-645-0923
Provider Enumeration Date:
04/14/2015