Provider First Line Business Practice Location Address:
211 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:
47501-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-254-1881
Provider Business Practice Location Address Fax Number:
812-254-1887
Provider Enumeration Date:
02/27/2007