Provider First Line Business Practice Location Address:
1299 E VOORHEES ST
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:
47802-3642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-460-0730
Provider Business Practice Location Address Fax Number:
812-462-2858
Provider Enumeration Date:
05/27/2006