Provider First Line Business Practice Location Address:
402 E 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47542-9295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-684-0095
Provider Business Practice Location Address Fax Number:
812-684-0096
Provider Enumeration Date:
10/11/2011