Provider First Line Business Practice Location Address:
830 S 6TH 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:
47807-4712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-8080
Provider Business Practice Location Address Fax Number:
812-909-6737
Provider Enumeration Date:
11/10/2022