Provider First Line Business Practice Location Address:
7125 HWY 66
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47638-9635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-673-4947
Provider Business Practice Location Address Fax Number:
812-673-4846
Provider Enumeration Date:
12/16/2009