Provider First Line Business Practice Location Address:
1606 NORTH 7TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47804-6273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-238-7210
Provider Business Practice Location Address Fax Number:
812-242-3070
Provider Enumeration Date:
05/15/2006