Provider First Line Business Practice Location Address:
4211 STATE ROUTE 261
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47630-2764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-962-7353
Provider Business Practice Location Address Fax Number:
270-685-1874
Provider Enumeration Date:
09/19/2005