Provider First Line Business Practice Location Address:
1200 S CENTER 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:
47802-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-753-7308
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2023