Provider First Line Business Practice Location Address:
2200 MARKET ST
Provider Second Line Business Practice Location Address:
C/O ST CATHERINE'S REGIONAL HOSPITAL
Provider Business Practice Location Address City Name:
CHARLESTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47111-9553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-256-7676
Provider Business Practice Location Address Fax Number:
812-256-7419
Provider Enumeration Date:
11/01/2006