Provider First Line Business Practice Location Address:
1810 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47542-9387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-683-9600
Provider Business Practice Location Address Fax Number:
812-683-2972
Provider Enumeration Date:
06/25/2010