Provider First Line Business Practice Location Address:
6401 S US HIGHWAY 41
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:
47802-4749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-298-3002
Provider Business Practice Location Address Fax Number:
812-298-3044
Provider Enumeration Date:
07/17/2008