Provider First Line Business Practice Location Address:
399 HOSPITAL LN
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:
47802-4394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-645-2308
Provider Business Practice Location Address Fax Number:
317-520-8200
Provider Enumeration Date:
05/08/2019