Provider First Line Business Practice Location Address:
11 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47501-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-254-7922
Provider Business Practice Location Address Fax Number:
812-254-1250
Provider Enumeration Date:
09/23/2006